Flu Vaccine Coding 2017
Time to make sure your practice is current on the 2016-2017 codes and payment allowances for flu vaccine and administration.
The Centers for Medicare & Medicaid Services (CMS) has posted the following pricing information on its website.
Code Payment Allowance Update:
The Medicare Part B payment allowance limits for seasonal influenza and pneumococcal vaccines are 95 percent of the Average Wholesale Price (AWP) (or at reasonable cost in a hospital outpatient department).
Effective for services provided on August 1, 2016, through July 31, 2017, the following Medicare Part B payment allowances for HCPCS Level II and CPT(R) codes apply.
Note that CPT(R) 90674 is a new code for 2017, and certain code descriptors are revised for 2017 to include dosage rather than age. The changes are reflected, below.
Payment Allowances and Effective Dates for the 2016-2017 Flu Season:
? CPT 90630 Payment allowance is $20.343. Effective dates: 8/1/2016-7/31/2017
? CPT 90653 Payment allowance is $37.383. Effective dates: 8/1/2016-7/31/2017
? CPT 90656 Payment allowance is $17.717. Effective dates: 8/1/2016-7/31/2017
? CPT 90657 Payment allowance is pending. Effective dates: 8/1/2016-7/31/2017
? CPT 90661 Payment allowance is pending. Effective dates: 8/1/2016-7/31/2017
? CPT 90662 Payment allowance is $42.722. Effective dates: 8/1/2016-7/31/2017
? CPT 90672 Payment allowance is $26.876. Effective dates: 8/1/2016-7/31/2017
? CPT 90673 Payment allowance is $40.613 Effective dates: 8/1/2016-7/31/2017
? CPT 90674 Payment allowance is $22.936 Effective dates: 8/1/2016-7/31/2017
? CPT 90685 Payment allowance is $26.268. Effective dates: 8/1/2016-7/31/2017
? CPT 90686 Payment allowance is $19.032. Effective dates: 8/1/2016-7/31/2017
? CPT 90687 Payment allowance is $9.403. Effective dates: 8/1/2016-7/31/2017
? CPT 90688 Payment allowance is $17.835. Effective dates: 8/1/2016-7/31/2017
? HCPCS Q2035 Payment allowance is $16.284. Effective dates: 8/1/2016-7/31/2017
? HCPCS Q2037 Payment allowance is $16.284. Effective dates: 8/1/2016-7/31/2017
? HCPCS Q2039 Flu Vaccine Adult – Not Otherwise Classified payment allowance is to be determined by the local claims processing contractor with effective dates of 8/1/2016-7/31/2017.
Additional information on 2016-2017 Influenza Vaccines pricing is available in MM9758, which is available in the ‘Downloads’ section below. Information for some codes is pending FDA approval. Updates to the payment limits and effective dates will be posted to this webpage.
Billing Guidelines:
Medicare pays for one seasonal influenza virus vaccination per influenza season (12 months do not have to pass). Annual Part B deductible and coinsurance amounts do not apply for the influenza virus and the pneumococcal vaccinations. All physicians, non-physician practitioners, and suppliers who administer these vaccinations must take assignment on the claim for the vaccine.
Medicare will pay both administration fees when a beneficiary receives both the seasonal influenza virus and the pneumococcal vaccines on the same day. Report ICD-10-CM diagnosis code Z23 Encounter for immunization when an individual receives both vaccines, but report separate administration codes for the seasonal influenza virus (G0008) and pneumococcal (G0009) vaccines.
Note, however, that a separate roster claim must be prepared for the pneumococcal vaccine and the seasonal influenza virus vaccine.