Vaccine Billing Guide

As the COVID-19 vaccine is gradually rolled out across Manitoba, physicians are facing an increasing number of questions from patients, and some are preparing to offer immunizations in their practice.

Guidance on Billing and Remuneration

We will soon release guidance to support physicians offering the vaccine, as well as offering patient counseling and advice to support vaccine decision-making.

Doctors Manitoba has compiled the following advice to answer questions about remuneration and offer guidance about submitting claims for visits.

Remuneration for COVID-19 Vaccine Injections

Manitoba Health has established a new tariff for COVID-19 vaccine injections. The tariff is $20, nearly double the standard flu shot tariff, as it covers:

  • Injection of the vaccine,
  • Verifying each patient meets provincial eligibility criteria,
  • Obtaining patient consent, and
  • Additional administrative requirements, such as submitting claims within 48 hours and weekly detailed reporting.

This cannot be claimed for a fully delegated procedure. Physicians must participate for this tariff to be claimed (e.g. administer the vaccine personally and/​or speak with the patient personally).

The tariff codes depend on the vaccine product being used:

  • Pfizer BioNTech: Tariff 8251 for each dose
  • Pediatric Pfizer BioNTech: Tariff 8292 for each dose 
  • Moderna: Tariff 8252 for each full dose
  • Moderna booster: Tariff 8293 for each half dose 
  • AstraZeneca: Tariff code 8256 for each dose
  • Johnson & Johnson (Janssen): Tariff code 8255 for the single dose
  • Novavax: Tariff code 8291 for each dose.
  • Moderna Infant-Pediatric (age 6m-5y): Tariff 8261 for each dose.

Claims for vaccine injections that do not match the information that Public Health maintains about specific product you have received will not be paid.

Claims must also include an immunization reason, using a list of reasons set by Manitoba Health. The reasons will align with current provincial eligibility criteria or potential future changes. These include:

  1. PCH Resident
  2. Health Care Worker
  3. Community with disproportionate disease impact
  4. Congregate living, other
  5. Routine (age-based indication)
  6. Essential worker
  7. Pre-existing Condition

The tariff claims are being used to track immunizations. Therefore, a visit may not be claimed as a substitute for claiming the COVID-19 vaccination tariff when administering the vaccine.

Visits: responding to patient’s questions and concerns

These are new vaccines, for a new disease, and it’s natural for patients to have more questions or concerns. While the vaccines offer a light at the end of a very long pandemic tunnel, vaccine hesitancy is a major concern as all jurisdictions strive to reach herd immunity to return to a more normal way of life. Surveys have shown that physicians are the most trusted profession or institution to address concerns or hesitations about these new vaccines.

While the tariff for the actual administration of the vaccine includes establishing a​“vaccine confident” patient’s eligibility and obtaining their consent, there are times when physicians must spend more time with patients. In many of these situations, a visit may also be claimed. 

When to Claim a Visit for COVID-19 Vaccination

Patients may need advice from a physician beyond the standard informed consent conversation that is included as part of the vaccine injection tariff. In these situations, a visit can be claimed. This can occur on the same day as an injection, or in advance. 

If the patient attends at you office for the sole purpose of discussing vaccination, then you can claim an existing visit tariff. If the patient has another visit for an unrelated medical issue on the same day, there is a new special tariff available (see separate section below for details). 

For example, you may claim a visit if you:

  • Respond to patient concerns to address their vaccine hesitancy,
  • Assess more complex medication situations to advise a patient on risks and benefits,
  • Discuss indications and contraindications, and/​or
  • Answer a patient’s detailed questions about the vaccine and their personal suitability

If you are claiming a visit on the same day as the vaccine injection, it is important to document the reason for the visit (e.g.​“patient was vaccine hesitant” or​“patient has history of allergies and needed to ensure risk for reaction was low”). Some patients will receive the vaccine elsewhere (e.g. provincial super site or pharmacy), but may still seek their physician’s advice about the vaccine. In these situations, a visit can be claimed.

Vaccine Hesitancy Advice — Same Day as Another
Visit (NEW)

Many physicians are trying to promote vaccination during patient visits for unrelated issues. In some cases, this can lead to extended visits to respond to patients’ vaccine concerns and hesitancy. 

There is now a Vaccine Hesitancy Advice tariff for this specific situation. This tariff should only be claimed on the same day as another in person visit, and only when the physician spends 10+ minutes on vaccine advice and counselling.

Please review the new tariff rules below by expanding this section:

COVID-19 Immunization Hesitancy Advice $37.80

Effective July 13, 2021 — during the pandemic period.

Please be aware of ICD code V655 — Person with feared complaint in whom no diagnosis was made. This ICD code should be considered when claiming for this service.

Billing Note
  1. Payable for COVID-19 immunization advice provided in person to patients who have not received a COVID-19 vaccine. Advice may include, but is not limited to, discussions on indications, contraindications, benefits and risks of immunization, questions concerning immunization in general, questions regarding a specific vaccine product, or addressing concerns about after effects.
  2. Payable in addition to a visit for a condition not related to vaccination 
  3. Payable in addition to a vaccination tariff 
  4. Payable if patient elects not to receive vaccine during the visit
  5. Not payable in addition to a visit arranged for the express purpose of receiving a COVID vaccination.
  6. Patient/​Physician contact time for the advice shall be a minimum of 10 minutes, exclusive of time spent on the unrelated visit.
  7. Service cannot be delegated to a nurse or other employee of the physician’s practice.
  8. Claimable once per patient, per physician
  9. Physicians shall provide equitable access for vaccinations for all eligible Manitobans regardless of whether the patient is in the physician’s existing panel of patients. 
  10. After Hours Premiums may not be claimed in addition.

Further Reading