Claims for the nasal flu mist, flu and pneumonia injections

Some pediatric patients who are eligible to receive the flu vaccine may receive the vaccine via nasal mist or spray. Alberta Health has advised that the administration of the nasal flu mist may be submitted to the Alberta Health Care Insurance Plan as HSC 03.02A brief visit if the physician provides the service.

If the physician provided a visit service as well as the nasal mist vaccine on the same day, only one visit may be claimed (03.03A, 03.04A as appropriate). Chart notes should reflect that a visit and vaccine service occurred.

If the nurse provided the vaccine and no other services were provided, nothing may be claimed to AHCIP for the mist.

13.59A Flu and pneumonia vaccine reminders – injections

Flu and pneumonia vaccine season is fast approaching. Here are some reminders: 

  • 13.59A may be claimed in addition to a visit when the physician provides a visit service in accordance with the Governing Rules.
  • In order to claim for more than one injection at the same encounter simply change the number of calls to the appropriate number. If more than two injections are provided at the same encounter, text must be added to the claim.
  • For injections provided in the physician’s office – Injections for flu or pneumonia may be claimed as 13.59A when the nurse provides the injections (Bulletin MED 97). A visit service may not be claimed in addition to a nurse-provided injection unless the physician has provided a visit service in accordance with the Governing Rules. Nurse-provided injections in the hospital may not be submitted by a physician to Alberta Health for payment.
  • The only injections that are billable to Alberta Health when they are provided by the nurse are for flu, pneumonia (13.59A) and allergy desensitization (13.42A). All other injections must be provided by the physician in order to submit a claim to Alberta Health.

For more advice from AMA staff on any billing issues, including explanations of recent billing changes, please email AMA billing staff.

The AMA advances patient-centered, quality care by advocating for and supporting physician leadership and wellness.