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.

19 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

  6. Nikki Washington says:

    Have you tried adding a Q Code?

  7. Jade Mound says:

    Our nurses go to the school and give flu shots. Are we able to bill them? At this time, there isn’t a contract in place or a dedicated room. At a previous facility I had worked at, we were able to bill shots that were given at an outside location. Can I get some clarifications on this?

  8. Mahlah says:

    We are having some trouble with medicare. We billed Afluria Quad 90471,90688, Medicare covered 90688 however denied the admin code so we changed and billed admin code G0008 and 90688. Correct if I am wrong but the correct way to bill to this to medicare is G0008 and Q2035?

  9. mahlah lewis says:

    We are having some trouble with medicare. We billed Afluria Quad 90471,90688, Medicare covered 90688 however denied the admin code so we changed and billed admin code G0008 and 90688. Correct if I am wrong but the correct way to bill to this to medicare is G0008 and Q2035?

  10. Andrea says:

    Can anyone provide guidance on when to bill G0008 vs 90471?

  11. Valencia Harold says:

    G0008 and Q2035 is correct also, G0008 is for medicare only and 90471 for others

  12. Karen says:

    When billing for the flu vaccine with the G0008, as well as the TDap vaccine with 90471, given on the same day, we are getting a denial from Medicare stating a Modifier is needed. There is already a modifier on the E/M Level. Does anyone know what modifier is required?

  13. Karen E says:

    When billing for the flu vaccine with the G0008, as well as the TDap vaccine with 90471, given on the same day, we are getting a denial from Medicare stating a Modifier is needed. There is already a modifier on the E/M Level. Does anyone know what modifier is required?

  14. JDR says:

    For those billing 90471 and getting denied, is there an E&M on the same encounter? Should it be billed with a modifier -25??

  15. Rose Mary says:

    is this with Rural Health Clinics as well.?? to use the G0008?

  16. Lesa Durbin says:

    I have billed the Q2038 & Q2039 for the last 2 years since I have been working in my current position. Now this year Medicare is wanting the CPT codes instead of the HCPCS codes. I have changed them, but of course they are coming back with “the frequency of service is not supported” I was told by a Medicare rep I would have to appeal these. I find this to be unreasonable since the code is in the coding books and the normal process of billing this service, it is also listed (Mln education tool, for Medicare part B immunization billing). I only have 2 previous years experience will billing these charges to Medicare. Does anyone know if possibly they will add the HCPCS codes Q2038 & Q2039 on to the Payment allowances for the 2018-2019 Flu Season?

  17. Rose says:

    Is anyone having problems getting flu shots paid by Medicare HMO’s such as United Health care Medicare plans, MediBlue, Etc?

  18. Rosetta says:

    I use 90658 and 90471 for commercial insurances and have no problem getting paid. For Medicare patients, I use Q2036 and G0008 and seems to be working fine. I have a problem getting paid by HMO Medicare insurances, such as United Health Care Medicare plans/Aetna Medicare etc. Does anyone have any codes for those insurances that get the flu vaccine and administration paid?

  19. Debra says:

    Question: Our nurses get the vitals on our pediatric patients and determine that the patient does not have a fever or any other complaints at time of visit and then administer the Flu Vaccine to our pediatric patients; can we bill a 99211 along with the flu cpt codes? Ex: 99211, 90686, G0008,59

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