2019-2020 Influenza Vaccine Codes and Pricing
With schools and colleges back in session, you can only hope patients start coming in for their influenza vaccine, so communities can keep the spread of seasonal flu to a minimum this year. Healthcare providers should prepare for the flux of injections by updating their billing systems with the 2019 Average Sales Price (ASP) Drug Pricing files and reading the latest vaccine recommendations.
Vaccine codes and payment allowances for the 2019-2020 season are shown in Table A. These payment allowances are effective Aug. 1, 2019, through July 31, 2020. Download the 2019 Average Sales Price (ASP) Drug Pricing Files for up-to-date pricing information on all Medicare Part B drugs.
Table A: Payment Allowances and Effective Dates for the 2019-2020 Flu Season
|Code||Descriptor||Labeler Name||Drug Name||Payment Allowance|
|90653||Influenza vaccine, inactivated (IIV), subunit, adjuvanted, for intramuscular use||Seqirus||Fluad||$59.530|
|90662||Influenza virus vaccine (IIV), split virus, preservative free, enhanced immunogenicity via increased antigen content, for intramuscular use||Sanofi Pasteur||Fluzone High-Dose)||$56.006|
|90672||Influenza virus vaccine, quadrivalent, live (LAIV4), for intranasal use||MedImmune||FluMist Quadrivalent||$26.876|
|90674||Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage, for intramuscular use||Seqirus||Flucelvax Quadrivalent (Pres Free)||$28.130|
|90682||Influenza virus vaccine, quadrivalent (RIV4), derived from recombinant DNA, hemagglutinin (HA) protein only, preservative and antibiotic free, for intramuscular use||Sanofi Pasteur||Flublok Quadrivalent||$56.006|
|90685||Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, 0.25 mL dosage, for intramuscular use||Sanofi Pasteur
|Fluzone Quadrivalent 0.25ml (Pres Free)
Afluria Quadrivalent 0.25 ml (Pres Free)
|90686||Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, 0.5 mL dosage, for intramuscular use||GlaxoSmithKline
|Fluarix Quadrivalent (Pres free)
Flulaval Quadrivalent (Pres Free)
Fluzone Quadrivalent (Pres Free)
Afluria Quadrivalent (2019/2020) (Pres Free)
|90687||Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.25 mL dosage, for intramuscular use||Sanofi Pasteur
|Fluzone Quadrivalent 0.25ml
Afluria Quadrivalent 0.25ml
|90688||Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.5 mL dosage, for intramuscular use||GlaxoSmithKline
|90756||Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, antibiotic free, 0.5 mL dosage, for intramuscular use||Seqirus||Flucelvax Quadrivalent||$26.657|
The Medicare Part B payment allowance limits for seasonal influenza and pneumococcal vaccines are 95% of the Average Wholesale Price (AWP) as reflected in the published compendia except where the vaccine is furnished in a hospital outpatient department. When the vaccine is furnished in the hospital outpatient department, payment for the vaccine is based on reasonable cost.
Novitas Solutions, Medicare Administrative Contractor for Jurisdiction H and L, has published administration fees for the following three HCPCS Level II codes on its website. (Check your MAC’s website for applicable administrative fees.)
Annual Part B deductible and coinsurance amounts do not apply for the influenza virus and the pneumococcal vaccinations. All physicians, non-physician practitioners, and suppliers who administer these vaccinations must take assignment on the claim for the vaccine, according to the Centers for Medicare & Medicaid Services (CMS).
Read “How to Code Flu – from Prevention to Care” for guidance on how to code flu shots.
Primary Changes and Updates in CDC Recommendations
“Routine annual influenza vaccination of all persons aged ≥6 months who do not have contraindications continues to be recommended,” per the Centers for Disease Control and Prevention (CDC). The American Academy of Pediatrics (AAP) says it will no longer express a preference for the flu shot over nasal spray vaccine for children during the 2019-2020 flu season, and is recommending using the flu shot (inactivated influenza vaccine, IIV) as the primary vaccine choice.
Read AAP’s full statement regarding the flu vaccine for 2019-2020.
Be aware of two recent regulatory actions:
- In October 2018, FDA approved an expanded age indication for Afluria Quadrivalent (IIV4). Previously licensed for persons aged ≥5 years, Afluria Quadrivalent (IIV4) is now licensed for persons aged ≥6 months. The dose volume is 0.25 mL per dose (containing 7.5 µg of hemagglutinin (HA) per vaccine virus) for children aged 6 through 35 months and 0.5 mL per dose (containing 15 µg of HA per vaccine virus) for all persons aged ≥36 months (≥3 years).
- In January 2019, FDA approved a change in dose volume for Fluzone Quadrivalent (IIV4). Previously, the dose volume for children aged 6 through 35 months was 0.25 mL (containing 7.5 µg of HA per vaccine virus). Children aged 6 through 35 months who receive Fluzone Quadrivalent may now receive either 0.25 mL (containing 7.5 µg of HA per vaccine virus) or 0.5 mL (containing 15 µg of HA per vaccine virus) per dose. Children aged ≥36 months (≥3 years) and adults should receive 0.5 mL per dose.
- Get more information regarding CDC recommendations.
What’s Going Around This Year?
The CDC reports the 2019–20 U.S. trivalent influenza vaccines will contain:
- an A/Brisbane/02/2018 (H1N1)pdm09–like virus,
- an A/Kansas/14/2017 (H3N2)–like virus, and
- a B/Colorado/06/2017–like virus (Victoria lineage).
The 2019–20 U.S. quadrivalent influenza vaccines will contain HA derived from these three viruses and an additional influenza B virus HA, a B/Phuket/3073/2013–like virus (Yamagata lineage). Compared with the 2018–19 season, the composition for 2019–20 represents updates in the influenza A(H1N1)pdm09 and influenza A(H3N2) components of the vaccine.
Grohskopf LA, Alyanak E, Broder KR, Walter EB, Fry AM, Jernigan DB. Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices — United States, 2019–20 Influenza Season. MMWR Recomm Rep 2019;68(No. RR-3):1–21. DOI: http://dx.doi.org/10.15585/mmwr.rr6803a1