Influenza Vaccine Payment Allowances
The Medicare Part B payment allowance limits for influenza and pneumococcal vaccines are 95 percent of the AWP as reflected in the published compendia except where the vaccine is furnished in a hospital outpatient department, Rural Health Clinic (RHC), or Federally Qualified Health Center (FQHC). Where the vaccine is furnished in the hospital outpatient department, RHC, or FQHC, payment for the vaccine is based on reasonable cost.
CPT 90654 Payment allowance is $18.918. Effective dates: 8/1/2014-7/31/2015
CPT 90655 Payment allowance is pending. Effective dates: 8/1/2014-7/31/2015
CPT 90656 Payment allowance is $14.096. Effective dates: 8/1/2014-7/31/2015
CPT 90657 Payment allowance is $6.022. Effective dates: 8/1/2014-7/31/2015
CPT 90661 Payment allowance is $21.666. Effective dates: 8/1/2014-7/31/2015
CPT 90662 Payment allowance is $33.374. Effective dates: 8/1/2014-7/31/2015
CPT 90672 Payment allowance is $25.736. Effective dates: 8/1/2014-7/31/2015
CPT 90673 Payment allowance is pending. Effective dates: 8/1/2014-7/31/2015
CPT 90685 Payment allowance is $23.900. Effective dates: 8/1/2014-7/31/2015
CPT 90686 Payment allowance is $17.984. Effective dates: 8/1/2014-7/31/2015
CPT 90687 Payment allowance is $9.134. Effective dates: 8/1/2014-7/31/2015
CPT 90688 Payment allowance is $16.844. Effective dates: 8/1/2014-7/31/2015
HCPCS Q2035 Payment allowance is $11.885. Effective dates: 8/1/2014-7/31/2015
HCPCS Q2036 Payment allowance is $8.579. Effective dates: 8/1/2014-7/31/2015
HCPCS Q2037 Payment allowance is $15.396. Effective dates: 8/1/2014-7/31/2015
HCPCS Q2038 Payment allowance is $12.044. Effective dates: 8/1/2014-7/31/2015
HCPCS Q2039 Flu Vaccine Adult – Not Otherwise Classified payment allowance is to be determined by the local claims processing contractor with effective dates of 8/1/2014-7/31/2015.
* Payment allowances for codes for products that have not yet been approved will be provided when the products have been approved and pricing information becomes available to CMS.
