IT’S THE HOLIDAY SEASON….TIME TO SPREAD THE FLU!
With all the weather changes we have experienced in the south over the past few months, getting the flu has been the last thing on anyone’s mind. 80 degree temps here in Kentucky in November is unheard of! We’ve all been taking advantage of getting out in the fresh air (flu? what flu?).
Well, now we are experiencing our first “Arctic Blast” and my first trip to Kroger this week resulted in witnessing probably the most embarrassing thing we as parents experience….projectile vomiting from a child in the grocery store. Okay, maybe not the most embarrassing thing in the world but one that certainly had me running for the hand sanitizer and masks (no-I didn’t stick around to help).
And yes, remembering that in fact, the flu season is upon us.
Guidelines for Billing Influenza Vaccines
Medicare pays for one seasonal influenza virus vaccination per influenza season (12 months do not have to pass). Annual Part B deductible and coinsurance amounts do not apply for the influenza virus and the pneumococcal vaccinations. All physicians, non-physician practitioners, and suppliers who administer these vaccinations must take assignment on the claim for the vaccine.
Medicare will pay both administration fees when a beneficiary receives both the seasonal influenza virus and the pneumococcal vaccines on the same day. Report ICD-10-CM diagnosis code Z23 Encounter for immunization when an individual receives both vaccines, but report separate administration codes for the seasonal influenza virus (G0008) and pneumococcal (G0009) vaccines.
Medicare Payment Allowances for this flu season (8/1/2016-7/31/2017)
| CPT® Code | Payment Allowance | |
| 90630 | Influenza split virus vaccine, quadrivalent (IIV4), preservative free, for intradermal use | $20.343 |
| 90653 | Influenza virus vaccine, inactivated, subunit, adjuvanted, for intramuscular use | $37.383 |
| 90654 | Influenza virus vaccine, split virus, preservative-free, for intradermal use | Pending |
| 90655 | Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, 0.25 mL dosage, for intramuscular use | Pending |
| 90656 | Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, 0.5 mL dosage, for intramuscular use | $17.717 |
| 90657 | Influenza virus vaccine, trivalent (IIV3), split virus, when administered to children 6–35 months of age, for intramuscular use | Pending |
| 90661 | Influenza virus vaccine, trivalent (ccIIV3), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage, for intramuscular use | Pending |
| 90662 | Influenza virus vaccine, split virus, preservative free, enhanced immunogenicity via increased antigen content, for intramuscular use | $42.722 |
| 90672 | Influenza virus vaccine, quadrivalent, live (LAIV4), for intranasal use | $26.876 |
| 90673 | Influenza virus vaccine, trivalent (RIV3), derived from recombinant DNA (RIV3), hemagglutinin (HA) protein only, preservative and antibiotic free, for intramuscular use | $40.613 |
| 90674 | Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage, for intramuscular use
*NOTE-Claims for this code must be held until 1/1/17
| $22.936 |
| 90685 | Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, 0.25 mL dosage, for intramuscular use | $26.268 |
| 90686 | Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, 0.5 mL dosage, for intramuscular use | $19.032 |
| 90687 | Influenza virus vaccine, quadrivalent (IIV4), split virus, when administered to children 6–35 months of age, for intramuscular use | $9.403 |
| 90688 | Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.25 mL dosage, for intramuscular use | $17.835 |
| HCPCS Level II Code | Payment Allowance | |
| Q2035 | Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Afluria) | $16.284 |
| Q2036 | Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Flulaval) | $16.284 |
| Q2037 | Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Fluvirin) | Pending |
| Q2038 | Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Fluzone) | Pending |
| Q2039 | Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (not otherwise specified) | Flu Vaccine Adult – Not Otherwise Classified: Payment allowance is to be determined by the local claims processing contractor. |
The payment allowance for some codes is still pending. Check the CMS website periodically for updates.
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