A quick reference of Medicare Immunization Billing
Flu shots covered by Medicare for the year 2012
CPT 90654 – Influenza virus vaccine, split virus, preservative-free, for intradermal use, for adults ages 18 – 64 of age.
CPT 90655 – Influenza virus vaccine, split virus, preservative free, when administered to children 6 – 35 months of age, for intramuscular use
CPT 90656 – Influenza virus vaccine, split virus, preservative free, when administered to individuals 3 years and older, for intramuscular use
CPT 90657 – Influenza virus vaccine, split virus, when administered to children 6 – 35 months of age, for intramuscular use
CPT 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)
CPT Q2035 – Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Afluria)
CPT Q2036 – Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Flulaval)
CPT Q2037 – Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Fluvirin)
CPT Q2038 – Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Fluzone)
CPT Q2039 – Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Not Otherwise Specified)
CPT 90660 – Influenza virus vaccine, live, for intranasal use
CPT 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
CPT 90669 – Pneumococcal conjugate vaccine, 7 valent, for intramuscular use
CPT 90670 – Pneumococcal conjugate vaccine, 13 valent, for intramuscular use
CPT 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
CPT 90740 – Hepatitis B vaccine, dialysis or immunosuppressed patient dosage (3 dose schedule), for intramuscular use
CPT 90743 – Hepatitis B vaccine, adolescent (2 dose schedule), for intramuscular use
CPT 90744 – Hepatitis B vaccine, pediatric/adolescent dosage (3 dose schedule), for intramuscular use
CPT 90746 – Hepatitis B vaccine, adult dosage, for intramuscular use
CPT 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
