Annual Seasonal Flu Payment Allowance Update

The Centers for Medicare & Medicaid Services (CMS) released, Oct. 2, an annual update to influenza (flu) payment allowances for the 2009-2010 season.

The payment allowances for the following CPT® codes are effective Sept. 1:

CPT®	Descriptor	Payment
90655	Influenza virus vaccine, split virus, preservative free, when administered to children 6-35 months of age, for intramuscular use	$15.447
90656	Influenza virus vaccine, split virus, preservative free, when administered to individuals 3 years and older, for intramuscular use	$12.542
90657	Influenza virus vaccine, split virus, when administered to children 6-35 months of age, for intramuscular use	$5.684
90658	Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use	$11.368
90660	Influenza virus vaccine, live, for intranasal use	$22.316

Remember that to get paid for 90660, documentation must show it to be medically reasonable and necessary.

These payment allowances are based on 95 percent of the average wholesale price (AWP) except when furnished in a hospital outpatient department, rural health clinic (RHC) or federally qualified health center (FQHC), where they are based on reasonable cost.

Read CMS Transmittal 1824 for complete details.