It’s the holiday season….time to spread the Flu!

santa-hat

With all the weather changes we have experienced in the south over the past few months, getting the flu has been the last thing on anyone’s mind.  80 degree temps here in Kentucky in November is unheard of!  We’ve all been taking advantage of getting out in the fresh air (flu?  what flu?).

Well, now we are experiencing our first “Arctic Blast” and my first trip to Kroger this week resulted in witnessing probably the most embarrassing thing we as parents experience….projectile vomiting from a child in the grocery store.  Okay, maybe not the most embarrassing thing in the world but one that certainly had me running for the hand sanitizer and masks (no-I didn’t stick around to help).

And yes, remembering that in fact, the flu season is upon us.

Guidelines for Billing Influenza Vaccines

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.

Medicare Payment Allowances for this flu season (8/1/2016-7/31/2017)

CPT® Code Payment Allowance
90630 Influenza split virus vaccine, quadrivalent (IIV4), preservative free, for intradermal use $20.343
90653 Influenza virus vaccine, inactivated, subunit, adjuvanted, for intramuscular use $37.383
90654 Influenza virus vaccine, split virus, preservative-free, for intradermal use Pending
90655 Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, 0.25 mL dosage, for intramuscular use Pending
90656 Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, 0.5 mL dosage, for intramuscular use $17.717
90657 Influenza virus vaccine, trivalent (IIV3), split virus, when administered to children 6–35 months of age, for intramuscular use Pending
90661 Influenza virus vaccine, trivalent (ccIIV3), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage, for intramuscular use Pending
90662 Influenza virus vaccine, split virus, preservative free, enhanced immunogenicity via increased antigen content, for intramuscular use $42.722
90672 Influenza virus vaccine, quadrivalent, live (LAIV4), for intranasal use $26.876
90673 Influenza virus vaccine, trivalent (RIV3), derived from recombinant DNA (RIV3), hemagglutinin (HA) protein only, preservative and antibiotic free, for intramuscular use $40.613
90674 Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage, for intramuscular use

*NOTE-Claims for this code must be held until 1/1/17

$22.936
90685 Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, 0.25 mL dosage, for intramuscular use $26.268
90686 Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, 0.5 mL dosage, for intramuscular use $19.032
90687 Influenza virus vaccine, quadrivalent (IIV4), split virus, when administered to children 6–35 months of age, for intramuscular use $9.403
90688 Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.25 mL dosage, for intramuscular use $17.835

 

HCPCS Level II Code Payment Allowance
Q2035 Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Afluria) $16.284
Q2036 Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Flulaval) $16.284
Q2037 Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Fluvirin) Pending
Q2038 Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Fluzone) Pending
Q2039 Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (not otherwise specified) Flu Vaccine Adult – Not Otherwise Classified: Payment allowance is to be determined by the local claims processing contractor.

The payment allowance for some codes is still pending. Check the CMS website periodically for updates.

Resources:

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Part-B-Drugs/McrPartBDrugAvgSalesPrice/VaccinesPricing.html

https://www.cms.gov/Outreach-and-Education/Outreach/FFSProvPartProg/Provider-Partnership-Email-Archive-Items/2016-12-08-eNews.html?DLPage=1&DLEntries=10&DLSort=0&DLSortDir=descending#_Toc468862699

 

 

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