New Influenza Virus Vaccine Code – Q2034

HCPCS code Q2034 (Influenza virus vaccine, split virus, for intramuscular use (Agriflu))

Effective July 1, 2012, your Medicare carrier, FI, A/B MAC, or RHHI will begin accepting influenza virus vaccine code Q2034 (for dates of service on or after that date); and will add it to existing influenza virus vaccine CWF edits. For professional claims, for dates of service of July 1, 2012 through September 30, 2012, your contractor will use local pricing guidelines to determine payment rates for Q2034. After September 30, 2012, professional claims will be paid using the Medicare Part B payment limit for Q2034 according to the established payment rate in the October 2012 Part B drug pricing file.

Your contractor will pay for influenza virus vaccine code Q2034 Processing Institutional Claims based on reasonable cost to:

• Hospitals using type of bill (TOB) 12X and 13X;

• Skilled nursing facilities (SNF) using TOB 22X and 23X:

• Home health agencies (HHA) using TOB 34X;

• Hospital-based Renal Dialysis Facilities (RDF) using TOB 72X; and

• Critical access hospitals (CAH) using TOB 85X.

Your contractor will pay for influenza virus vaccine code Q2034 based on the lower of the actual charge or 95% of the Average Wholesale Price (AWP) to:

• Indian Health Service (IHS) hospitals using TOB 12X and 13X; and

• IHS CAHs using TOB 85X.

• Comprehensive Outpatient Rehabilitation Facilities (CORF) using TOB 75X; and

• Independent RDFs using TOB 72X.

Until systems are implemented, your contractor will hold institutional claims, containing code Q2034, with dates of service on or after July 1, 2012; and that are received before October 1, 2012. Upon implementation of CR7794 on October 1, contractors will begin to process the held claims.

Reference: http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM7794.pdf

See also ‘Complete list of Influenza virus vaccine CPT codes’

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