cpt code 90655

Influenza Vaccine Payment rates


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 CPT 90654, CPT 90655, CPT 90656, CPT 90657, CPT 90660, CPT 90661, CPT 90662, CPT 90672, CPT 90673, CPT 90685, CPT 90686, CPT 90687, and CPT 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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