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2011 Payment for Influenza Vaccines


Effective for claims with dates of service on or after January 1, 2011, the following CPT code will no longer be payable for Medicare:

CPT 90658 Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use.

Effective for claims with dates of service on or after October 1, 2010, the following HCPCS codes will be payable for Medicare:

Q2035 Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Afluria)

Q2036 Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Flulaval)

Q2037 Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Fluvirin)

Q2038 Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Fluzone)

Q2039 Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Not Otherwise Specified)

For dates of service on or after October 1, 2010, HCPCS codes Q2035, Q2036, Q2037, Q2038 and Q2039 (as listed above) will replace the CPT code 90658 for Medicare payment purposes during the 2010 – 2011 influenza season. However, these HCPCS codes will not be recognized by the Medicare claims processing systems until January 1, 2011, when CPT code 90658 will no longer be recognized.

Reference: http://www.cms.gov/MLNMattersArticles/downloads/MM7234.pdf


In addition to the above, below listed are the CPT codes to be reported for Seasonal Influenza Virus Vaccine and Administration

90655 Influenza virus vaccine, split virus, preservative free, when administered to children 6-35 months of age, for intramuscular use

90656 Influenza virus vaccine, split virus, preservative free, when administered to individuals 3 years and older, for intramuscular use

90657 Influenza virus vaccine, split virus, when administered to children 6-35 months of age, for intramuscular use

90658 Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Non covered for Medicare, Valid for Commercial insurances)

90660 Influenza virus vaccine, live, for intranasal use

90662 Influenza virus vaccine, split virus, preservative free, enhanced immunogenicity via increased antigen content, for intramuscular use

G0008 Administration of influenza virus vaccine

ICD codes for Influenza vaccine

If the sole purpose for the visit was to receive the seasonal influenza virus vaccine or if the seasonal influenza virus vaccine is the only service billed on a claim, the provider must report diagnosis code V04.81. However, if the purpose of the visit was to receive both the seasonal influenza virus vaccine and the pneumococcal vaccine, Medicare providers must report diagnosis code V06.6.

V04.81 Need for prophylactic vaccination and inoculation against viral diseases; influenza

V06.6 Need for prophylactic vaccination and inoculation against combinations of diseases; Streptococcus pneumoniae (pneumococcus) and influenza

Medicare Reimbursement

Payment Allowances Effective for Dates of Service between September 1, 2011 and August 31, 2012 as specified below

CPT 90654: $18.383
CPT 90655: $15.705
CPT 90656: $12.375
CPT 90657: $6.653
CPT 90660: $22.316
CPT 90662: $30.923

Q2035 (Afluria): $11.543
Q2036 (Flulaval): $8.784
Q2037 (Fluvirin): $13.652
Q2038 (Fluzone): $13.306
Q2039 (N.O.S.): locally priced

Also see Pneumococcal vaccine CPT codes.

Seasonal Influenza Virus, Pneumococcal and Hepatitis B - FAQs

Tricare Payments for Influenza vaccine - An update on new Q-codes and NDC request

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