2014-15 Flu Vaccine Payment Allowances

2014-15 Flu Vaccine Payment Allowances

For administration of the influenza vaccine to Medicare beneficiaries, report HCPCS Level II code G0008 Administration of influenza virus vaccine. This code bypasses deductible and coinsurance amounts for beneficiaries.

In an October 10 web post, Cahaba GBA warns, “We have seen providers bill CPTs 90741, 90472, and 90743 for the administration of the influenza vaccine. These codes are incorrect for Medicare and will be denied as a billing error.”

If you frequently bill HCPCS Level II code Q2039 Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (not otherwise specified), watch out. Documentation must include the name brand product used and the dosage. “If this information is missing, Q2039 will be rejected,” says Cahaba. Dollars to donuts, this guidance also applies to Q2035-Q2038.

Note: To better conform to the Center for Disease Control and Prevention’s (CDC) recommendations for the prevention and control of influenza, the Center for Medicare & Medicaid Services is changing the payment limit effective date from September 1 to August 1.

2014-2015 Flu Season Payment Allowances Effective August 1, 2014 through July 31, 2015:

CPT 90654 – $18.918

CPT 90655 – Payment allowance is pending.

CPT 90656 – $14.096

CPT 90657 – $6.022

CPT 90661 – $21.666

CPT 90662 – $33.374

CPT 90672 – $25.736

CPT 90673 – $37.193

CPT 90685 – $23.900

CPT 90686 – $17.984

CPT 90687 – $9.134

CPT 90688 – $16.844

HCPCS Q2035 – $11.885

HCPCS Q2036 – $8.579

HCPCS Q2037 – $15.396

HCPCS Q2038 – $12.044

HCPCS Q2039 – Payment allowance determined by local claims processing contractor.

The Immunization Action Coalition provides this convenient chart to assist with your influenza billing.

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Renee Dustman

Renee Dustman

Renee Dustman is executive editor at AAPC. She has a Bachelor of Science degree in Journalism and a long history of writing just about anything for just about every kind of publication there is or ever has been. She’s also worked in production management for print media, and continues to dabble in graphic design.
Renee Dustman

About Has 423 Posts

Renee Dustman is executive editor at AAPC. She has a Bachelor of Science degree in Journalism and a long history of writing just about anything for just about every kind of publication there is or ever has been. She’s also worked in production management for print media, and continues to dabble in graphic design.

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