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.

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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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