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Influenza Vaccine Payment rates for the year 2013 - 2014


CR 8433 provides payment allowances for the following seasonal influenza virus vaccine codes when payment is based on 95 percent of the AWP, except when furnished in a hospital outpatient department, a Rural Health Clinic, or a Federally Qualified Health Center for which payment is based on reasonable cost:

• Current Procedural Terminology (CPT) codes 90654, 90655, 90656, 90657, 90660, 90661, 90662, 90672, 90673, 90685, 90686, 90687, and 90688; and

• Healthcare Common Procedure Coding System (HCPCS) codes Q2033, Q2035, Q2036, Q2037, and Q2038.

The updated allowance rates are effective for dates of service (DOS) as follows (except when provided in a hospital outpatient department, RHC, or FQHC):

 
CPT 90654 Payment allowance is $18.918. Effective dates: 8/1/2013-7/31/2014

CPT 90655 Payment allowance is $17.243. Effective dates: 8/1/2013-7/31/2014

CPT 90656 Payment allowance is $12.398. Effective dates: 8/1/2013-7/31/2014

CPT 90657 Payment allowance is $6.022. Effective dates: 8/1/2013-7/31/2014

CPT 90661 Payment allowance is $20.663. Effective dates: 8/1/2013-7/31/2014

CPT 90662 Payment allowance is $31.823. Effective dates: 8/1/2013-7/31/2014

CPT 90672 Payment allowance is $24.596. Effective dates: 8/1/2013-7/31/2014

CPT 90673 Payment allowance is pending. Effective dates: 1/1/2014-7/31/2014

CPT 90685 Payment allowance is $23.228. Effective dates: 8/1/2013-7/31/2014

CPT 90686 Payment allowance is $19.409. Effective dates: 8/1/2013-7/31/2014

CPT 90687 Payment allowance is pending. Effective dates: pending-7/31/2014

CPT 90688 Payment allowance is pending. Effective dates: pending-7/31/2014

HCPCS Q2033 Payment allowance is pending. Effective dates: 8/1/2013-12/31/2013

HCPCS Q2035 Payment allowance is $11.543. Effective dates: 8/1/2013-7/31/2014

HCPCS Q2036 Payment allowance is $8.579. Effective dates: 8/1/2013-7/31/2014

HCPCS Q2037 Payment allowance is $14.963. Effective dates: 8/1/2013-7/31/2014

HCPCS Q2038 Payment allowance is $12.044. Effective dates: 8/1/2013-7/31/2014

HCPCS Q2039 Flu Vaccine Adult - Not Otherwise Classified payment allowance is to be determined by the local claims processing contractor with effective dates of 8/1/2013-7/31/2014.


Reference: http://cms.gov/Medicare/Medicare-Fee-for-Service-Part-B-Drugs/McrPartBDrugAvgSalesPrice/VaccinesPricing.html

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