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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:

  • AstraZeneca: Tariff code 8256 for each dose
  • Johnson & Johnson (Janssen): Tariff code 8255 for the single dose
  • Moderna: Tariff 8252 for each dose
  • Pfizer BioNTech: Tariff 8251 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.

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,
  • Assist a patient with enhanced consent (e.g. for pregnant, breastfeeding or immuno-suppressed patients), or
  • Answer a patient’s detailed questions about the vaccine and their personal suitability

If the immunization is provided at the same time as a visit for a separate purpose (e.g. annual examination, monitoring chronic condition, etc.), that visit can be claimed.

In cases like all of the above, it is important for physicians to:

  • Confirm the visit activities are not part of the special tariff established for the COVID-19 vaccine (e.g. confirming eligibility for a healthy, vaccine confident patient), and
  • Document the reason for the visit that goes beyond the more routine administration of the vaccine (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 or consult their physician to complete the enhanced consent process. In these situations, a visit can be claimed.

Further Reading