2011-2012 Influenza Vaccine Pricing Now Available

The 2011-2012 seasonal influenza vaccine payment limits are now available on the Centers for Medicare & Medicaid Services (CMS) website.

The Medicare Part B payment allowance limits for seasonal influenza and pneumococcal vaccines are 95 percent of the Average Wholesale Price (AWP), except where the vaccine is furnished in a hospital outpatient department. Payment for the vaccine furnished in the hospital outpatient department is based on reasonable cost.

Annual Part B deductible and coinsurance amounts do not apply for the influenza virus and the pneumococcal vaccinations.

Payment allowances effective for dates of service between Sept. 1, 2011 and Aug. 31, 2012 are:

  • 90654: $18.383
  • 90655: $15.705
  • 90656: $12.375
  • 90657: $6.653
  • 90660: $22.316
  • 90662: $30.923
  • Q2035 (Afluria): $11.543
  • Q2036 (Flulaval): $8.784
  • Q2037 (Fluvirin): $13.652
  • Q2038 (Fluzone): $13.306
  • Q2039 (N.O.S.): locally priced

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