2018-2019 Flu Vaccine Coding

2018-2019 Flu Vaccine Coding

It’s time to update your seasonal influenza vaccine roster for the 2018-2019 season.

Medicare provides coverage of the flu vaccine once per season (or more, if medically necessary) without any out-of-pocket cost to the Medicare patient. No deductible or co-payment/coinsurance applies. Healthcare providers are reimbursed for the vaccine and its administration.

The administration code for the seasonal influenza virus vaccine is HCPCS Level II G0008 Administration of influenza virus vaccine and the ICD-10-CM diagnosis code is Z23 Encounter for immunization.

Here are the CPT codes and payment allowances for the 2018-2019 flu vaccines.

​Payment Allowances and Effective Dates for the 2018-2019 Flu Season

Code Labeler Name Drug Name Payment Allowance Effective Dates
90653 Seqirus Inc Fluad (2018/2019) $54.673 08/01/2018 – 07/31/2019
90656 Seqirus Inc Afluria (2018/2019) $19.773 08/01/2018 – 07/31/2019
90662 Sanofi Pasteur Fluzone High-Dose (2018/2019) $53.373 08/01/2018 – 07/31/2019
90674 Seqirus Inc Flucelvax Quadrivalent (2018/2019) $24.047 08/01/2018 – 07/31/2019
90682 Sanofi Pasteur Flublok Quadrivalent (2018/2019) $53.373 08/01/2018 – 07/31/2019
90685 Sanofi Pasteur Fluzone Quadrivalent Pediatric (2018/2019) $21.813 08/01/2018 – 07/31/2019
90686 Seqirus Inc, GlaxoSmithKline,
Sanofi Pasteur
Afluria Quadrivalent (2018/2019), Fluarix Quadrivalent (2018/2019), Flulaval Quadrivalent (2018/2019), Fluzone Quadrivalent (2018/2019) [Preservative Free] $19.032 08/01/2018 – 07/31/2019
90687 Sanofi Pasteur Fluzone Quadrivalent Pediatric (2018/2019) $9.403 08/01/2018 – 07/31/2019
90688 Seqirus Inc, GlaxoSmithKline,
Sanofi Pasteur
Afluria Quadrivalent (2018/2019), Flulaval Quadrivalent (2018/2019), Fluzone Quadrivalent (2018/2019) $17.835 08/01/2018 – 07/31/2019
90756 Seqirus Inc Flucelvax Quadrivalent (2018/2019) $22.793 08/01/2018 – 07/31/2019
Q2035 Seqirus Inc Afluria (2018/2019) $18.236 08/01/2018 – 07/31/2019

Source: www.cms.gov

Note that newly-released CPT code 90689 Influenza virus vaccine quadrivalent (IIV4), inactivated, adjuvanted, preservative free, 0.25 mL dosage, for intramuscular use, is not on the list. This code was just accepted by the CPT Editorial Panel in May and is not effective until Jan. 1, 2019.

See the MLN booklet Mass Immunizers and Roster Billing for Influenza Virus and Pneumococcal Vaccinations for complete coding and billing guidelines.

Related Reading on the Knowledge Center:

How to Code Flu – from Prevention to Care

CPB : Online Medical Billing Course


CPT is a registered trademark of the American Medical Association. Copyright 2018 American Medical Association. All rights reserved.

Renee Dustman
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Renee Dustman

Executive Editor at AAPC
Renee Dustman, BS, AAPC MACRA Proficient, is an executive editor at AAPC. She holds a Bachelor of Science degree in Media Communications - Journalism. Renee has more than 20 years experience in print production and content management. Follow her on Twitter @dustman_aapc.
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Renee Dustman, BS, AAPC MACRA Proficient, is an executive editor at AAPC. She holds a Bachelor of Science degree in Media Communications - Journalism. Renee has more than 20 years experience in print production and content management. Follow her on Twitter @dustman_aapc.

5 Responses to “2018-2019 Flu Vaccine Coding”

  1. Tami Bennett CMA (AAMA) says:

    Can a transitional care management (TCM) patient get a flu shot at the appointment and will it be covered?

  2. Annabeth Carter says:

    is there a list of what insurances cover the flu vaccine

  3. Fred Salazar says:

    I am having problems billing Blue Cross Blue Shield of Texas for the flu vaccine administration. I had initially used G0008 but was told they no longer accept that code. I changed it to 90471 but was denied. The representative is stating that I need to use an add on code that is appropriate per CMS guidelines. Can you help out? I would appreciate it.

  4. Marie Diaz says:

    I have the same issue as Fred, can anyone help? Thanks, I would really appreciate it

  5. Marie Diaz says:

    I have the same issue as Fred, Can anyone help? I would really appreciate it

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