CPT influenza Virus Vaccine Code, 90674 will be paid by Medicare starting 1/3/2017
90674 is the latest in series of Flu Codes. The Centers for Medicare & Medicaid Services (CMS) announced in a recent transmittal, Medicare will pay for the newest CPT influenza virus vaccine, 90674. Payments won?t begin until January 3, 2017, as 2017 codes won?t go into effect until after the first of the year. However, claims with dates of services on or after August 1, 2016 will be covered.
CPT 90674 defined as, Influenza virus Vaccine, quadrivalent (ccIIV4), derived from cell cultures, sub-unit preservative and antibiotic free, 0.5 mL dosage, for intramuscular use is the latest in influenza codes added to the code set. The code is out of numerical sequence in the CPT book and is sequenced after CPT 90661.
The transmittal instructs Medicare administrative contractors to manually add the code with an effective date of service of August 1, 2016 with Type of Service V. v. MACs will pay for influenza virus vaccine code 90674 based on the lower of the actual charge or 95 percent of the Average Wholesale Price (AWP) to:
? Indian Health Services (IHS) hospitals submitting claims on TOB 12X and 13X
? IHS CAHs submitting claims on TOB 85X
? Comprehensive Outpatient Rehabilitation Facilities using TOB 75X
? Independent Renal Dialysis Facilities using TOB 72X
According to MLN Matters, number MM9763 MACs will hold institutional claims with code 90674 with dates of service on or after January 1, 2017, through February 20, 2017, until the Fiscal Intermediary Shared System (FISS) changes are implemented on February 20, 2017.
As usual, Medicare will use the CMS Season Influenza Pricing webpage to determine the payment rate for 90674.
Medicare will issue further instructions on how to handle claims for code 90674 with dates of service from August 1, 2017, through December 31, 2016.
It should be noted by coders that 90764 only pays for the vaccine product. Use codes 90460, 90464, 90471, 90472, 90473, and 90474 to report the administration of a vaccine. The evaluation and management (E/M) code should be reported separately, if appropriate.