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Revised Payment Indicator for Flu Vaccine (CPT 90689)


CPT- 90689 Influenza virus vaccine, quadrivalent (IIV4), inactivated, adjuvanted, preservative free, 0.25 mL dosage, for intramuscular use.

Guidelines:

The provider injects 0.25 mL of a four–strain influenza virus vaccine into a patient’s muscle to provide immunity to four forms of influenza, a severe and infectious respiratory disease; the vaccine is free of preservatives and derived from cell cultures of a killed virus and contains a substance that increases the patient’s immune response.

Payment Indicator for ASC:

CMS is revising the status indicator from “E1” to “L1” Influenza vaccine; pneumococcal vaccine. Packaged item/service; no separate payment made for CPT code 90689 retroactive to Jan. 1, 2019.

Currently, CPT code 90689 is assigned to status indicator “E1” in the OPPS to indicate that the vaccine is not paid by Medicare when submitted on outpatient claims. This policy is also applicable to ASCs. 

However, as noted in Change Request 10871 (Quarterly Influenza Virus Vaccine Code Update - January 2019), Transmittal 4141, dated September  27, 2018, effective for claims with dates of service on or after January 1, 2019, CPT 90689 will be payable by Medicare.

The vaccine is packaged in the ASC payment system; therefore, CMS revising the status indicator to "L1" (L1:Influenza vaccine; pneumococcal vaccine. Packaged item/service; no separate payment made.) for CPT code 90689 retroactive to January 1, 2019.

Please note that packaged codes should not be separately billed by ASCs

Click Here for Payment Status Indicator for All CPT codes
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