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A quick reference of Medicare Immunization Billing - 2012


Flu shots covered by Medicare for the year 2012

90654 – Influenza virus vaccine, split virus, preservative-free, for intradermal use, for adults ages 18 – 64 of age.

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

Q2034 – Influenza virus vaccine, split virus, for intramuscular use (Agriflu) (effective for dates of service on or after 07/01/12, and claims processed on or after 10/01/12)

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)

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

Administration Code: G0008

Diagnosis Code: V04.81

Frequency of Administration

Once per influenza season

Medicare may cover additional seasonal influenza virus vaccinations if medically necessary

Pneumococcal Vaccine

90669 – Pneumococcal conjugate vaccine, 7 valent, for intramuscular use

90670 – Pneumococcal conjugate vaccine, 13 valent, for intramuscular use

90732 – Pneumococcal polysaccharide vaccine, 23 valent, adult or immunosuppressed patient dosage, when administered to individuals 2 years or older, for subcutaneous or intramuscular use

Administration Code: G0009

Diagnosis Code: V03.82

Frequency of Administration

Once in a lifetime

Medicare may cover additional vaccinations based on risk

Pneumococcal and Seasonal Influenza Virus Vaccines received during the same visit

Use the above seasonal influenza virus and pneumococcal vaccine codes as applicable.

Administration Codes: Both G0008 for Influenza Virus and G0009 for Pneumococcal

Diagnosis Code: V06.6

Frequency of Administration

Follow administration guidelines for seasonal influenza virus and pneumococcal vaccines

Hepatitis B Vaccine

90740 – Hepatitis B vaccine, dialysis or immunosuppressed patient dosage (3 dose schedule), for intramuscular use

90743 – Hepatitis B vaccine, adolescent (2 dose schedule), for intramuscular use

90744 – Hepatitis B vaccine, pediatric/adolescent dosage (3 dose schedule), for intramuscular use

90746 – Hepatitis B vaccine, adult dosage, for intramuscular use

90747 – Hepatitis B vaccine, dialysis or immunosuppressed patient dosage (4 dose schedule), for intramuscular use

Administration Code: G0010

Please note: Outpatient Prospective Payment System [OPPS] hospitals should report 90471 or 90472, as appropriate, instead of G0010

Diagnosis Code: V05.3

Frequency of Administration

Scheduled doses required

Reference: http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/qr_immun_bill.pdf

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