Family physicians are essential to BC’s immunization efforts—particularly during respiratory illness season. To support these efforts, both Fee-for-Service (FFS) and Longitudinal Family Practice (LFP) payment models include specific respiratory immunization fee codes.
In this blog, we will share a summary of the latest billing guidance from BC Family Doctors for the 2025–2026 respiratory season.
Fee-for-Service (FFS) Billing for Respiratory Immunizations
The following respiratory immunization fee codes are billable year-round under the FFS model. These apply to influenza, pneumococcal, pertussis, and COVID-19 immunizations — including all indications for pertussis, not just pregnancy.
Important: FFS codes are not billable by physicians enrolled in the LFP Payment Model for the same settings in which they bill LFP.
| Code | Description | Rate |
| 10040 | Respiratory immunization for patients 19+ years (with visit) | $6.54 |
| 10041 | Respiratory immunization for patients 19+ years (without visit) | $16.67 |
Adults (19+ Years)
1. Immunization plus a visit for an unrelated reason
Bill 10040 along with the appropriate visit service (e.g., office, prenatal, counselling, consultation) when the immunization occurs during a visit for an unrelated reason.
2. Immunization alone
Bill 10041 when the appointment’s primary purpose is immunization only.
- You can bill up to 3 × 10041 if multiple immunizations (e.g., influenza, pneumococcal, and COVID-19) are provided in one visit.
- Use submission code “D” for the second and third 10041 claims to ensure acceptance.
- Example ICD-9 codes:
- Influenza – V048
- Pneumococcal – V05
- COVID-19 – C19
Children (≤18 Years)
All pediatric immunization fee codes are billable in addition to the applicable office visit codes 00100 or 12100.
For COVID-19 immunizations for patients 18 and under, use:
10047 – Pediatric COVID-19 Immunization Fee
Longitudinal Family Practice (LFP) Payment Model
Under the LFP model, physicians can bill for respiratory immunizations provided by an Allied Care Provider (ACP) employed directly by their practice team. This applies only from October 1, 2025, to March 31, 2026, as a temporary amendment to the LFP Payment Schedule.
| Code | Description | Rate |
| 98101 | LFP Respiratory Immunization Provided By an Allied Care Provider | $14 |
Eligibility Requirements
1. The physician must have billed both:
- 98000/98005 (Enrolment Code), and
- 98002 (Clinic-based Services Registration Code)
2. The immunization must be provided by an Allied Care Provider (ACP) who:
- Is a College-certified professional governed by a BC regulatory college.
- Has a scope of practice that includes providing medical or medically related patient services.
- Is employed by the physician’s practice and paid from practice earnings, without any cost recovery from a third party (e.g., Health Authority, Division of Family Practice, Ministry of Health).
3. Only the following respiratory immunizations are billable:
- Influenza (V048)
- Pneumococcal (V05)
- Pertussis (V036)
- COVID-19 (C19)
Billing Guidelines
- Payable for up to three immunizations per patient per day.
- Use submission code “D” for the second and third 98101 claims on the same day.
- Time codes and interaction codes are not payable for immunizations provided by an ACP.
- Clinic-based interaction limits (50 per day) and 30% non-panel service limits do not apply to 98101.
- Immunizations by physicians themselves (not ACPs) can still be billed under interaction codes 98031/98061 and 98022/98052, if all criteria are met.
Examples of Billing Scenarios
1. ACP-Only Visit
If the patient only receives immunizations from an ACP:
- Bill 98101 (up to three times with submission code “D” for the second and third).
- No clinic-based time or interaction codes are payable.
2. Physician and ACP on Same Day
If a patient is seen by both:
- Bill 98101 for the ACP’s immunization service(s).
- Bill applicable LFP interaction and time codes for the physician’s care as per the LFP Payment Schedule.
3. Multiple Immunizations by Physician
When a physician provides multiple immunizations (e.g., influenza and pertussis):
- Bill 98031/98061 and 98022/98052 if criteria are met.
- Only one interaction code (98022/98052) is payable per visit.
Key Takeaways
- Fee-for-service (FFS) respiratory immunization codes (10040, 10041, 10047) are billable year-round and apply to both adult and pediatric patients.
- LFP physicians can claim 98101 for respiratory immunizations provided by Allied Care Providers between Oct 1, 2025 – Mar 31, 2026.
- Physicians cannot bill FFS codes for services already covered under LFP billing in the same setting.
- Always use the appropriate ICD-9 codes and submission codes to ensure claims are accepted.
BC Family Docs Resources
For more information, refer to the Simplified LFP Guide and Temporary LFP Respiratory Immunization Provided by an Allied Care Provider documentation from the BC Ministry of Health.
Billing Resources in OSCAR Pro
- Creating an MSP Invoice
- Edit an Invoice
- How to Simulate and Generate Claims To Teleplan
- Patient Billing History and Statuses
- Billing Preferences
For more OSCAR Pro support articles, view our knowledge base here.