Find Flu Vaccine Codes Fast for Cleaner Medicare Claims

In early October 2019, flu activity was low, according to the Centers for Disease Control and Prevention (CDC). But hopefully vaccinations will land in the “widespread” category for this flu season. A high volume of services means a high volume of coding, though, so protect your Medicare reimbursement with this guidance on flu vaccination coding.

Scan This Table for Vaccine Coding and Payment Information

Medicare post the codes and payment allowances for influenza virus vaccinations (the supply) on the Seasonal Influenza Vaccines Pricing page. There can be updates, but as of Oct. 17, 2019, the page shows the codes, drugs (2019/2020 versions), and payment allowances in Table 1 for Aug. 1, 2019, to July 31, 2020. The Medicare page puts the data in code order, but below they’re in alphabetic order so you can search based on vaccine name.

 

TABLE 1: 2019/2020 Flu Vaccine Supply Pricing From Medicare
Vaccine Name Code Payment Allowance
Afluria Quadrivalent 90688 $17.835
Afluria Quadrivalent (Pres Free) 90686 $19.032
Afluria Quadrivalent 0.25ml 90687 $9.403
Afluria Quadrivalent 0.25 ml (Pres Free) 90685 $20.343
Fluad 90653 $59.530
Fluarix Quadrivalent (Pres Free) 90686 $19.032
Flublok Quadrivalent 90682 $56.006
Flucelvax Quadrivalent 90756 $26.657
Flucelvax Quadrivalent (Pres Free) 90674 $28.130
Flulaval Quadrivalent 90688 $17.835
Flulaval Quadrivalent (Pres Free) 90686 $19.032
FluMist Quadrivalent 90672 $26.876
Fluzone High-Dose 90662 $56.006
Fluzone Quadrivalent 90688 $17.835
Fluzone Quadrivalent (Pres Free) 90686 $19.032
Fluzone Quadrivalent 0.25ml 90687 $9.403
Fluzone Quadrivalent 0.25 ml (Pres Free) 90685 $20.343

 

Tip: If there is no code available for the flu vaccine supply used, there is HCPCS Level II code Q2039 (Influenza virus vaccine, not otherwise specified). Medicare Administrative Contractors (MACs) may set their own Part B payment allowance for this code, according to MLN Matters MM11428.

Accept Assignment, Do Not Apply Copayment

All physicians, nonphysician practitioners (NPPs), and suppliers who administer the seasonal influenza virus must accept Medicare assignment (meaning they accept the Medicare-approved amount for payment) on the claims for those vaccines, according to the MLN Educational Tool, “Medicare Part B Immunization Billing: Seasonal Influenza Virus, Pneumococcal, and Hepatitis B.”

The MLN document goes on to state that, “When physicians or suppliers agree to accept assignment, the Part B deductible, coinsurance, or copayment do not apply to the seasonal influenza virus, pneumococcal, and Hepatitis B vaccines or their administration.”

Don’t Stop at the Supply Code for Flu Vaccinations

For Medicare patients, remember that you should report administration code G0008 (Administration of influenza virus vaccine). Other payers may require you to use codes for administration from the CPT® code set, specifically from 90460-90474.

For the ICD-10-CM code, report Z23 (Encounter for immunization).

What About You?

Do you code for flu vaccinations? Do you find the coding to be straightforward, or have you encountered issues?

 

About 

Deborah works on a wide range of TCI SuperCoder projects, researching and writing about coding, as well as assisting with data updates and tool development for our online coding solutions. Since joining TCI in 2004, she’s covered the ins and outs of coding for radiology, cardiology, oncology and hematology, orthopedics, audiology, and more.

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