2020-2021 Influenza Vaccine Codes, Pricing, and Recommendations

With the novel coronavirus continuing to circulate and cause severe illness in the United States and worldwide, getting a flu vaccine is more important than ever. The 2020–21 influenza season will coincide with the continued circulation of coronavirus, so start planning now.

Common signs and symptoms of COVID-19 (e.g., fever, cough, and dyspnea) can also occur with influenza, which is why the Centers for Disease Control and Prevention (CDC) recommends that everyone six months and older receive a flu vaccination. This will reduce the prevalence of illness caused by influenza as well as reduce symptoms that might be confused with those of COVID-19. Make sure your practice is prepared for the flux of injections by updating your billing systems with the 2020 Average Sales Price (ASP) Drug Pricing Files and reading the latest vaccination guidance.

Vaccine Codes and Payment Allowances

Vaccine codes and payment allowances for the 2020-2021 season are shown in Table A. These payment allowances are effective Aug. 1, 2020, through July 31, 2021. Download the 2020 Average Sales Price (ASP) Drug Pricing Files for up-to-date pricing information on all Medicare Part B drugs.

The Medicare Part B payment allowance limits for seasonal influenza and pneumococcal vaccines are 95 percent of the Average Wholesale Price (AWP), as reflected in the published compendia, except where the vaccine is furnished in a hospital outpatient department, Rural Health Clinic (RHC), or Federally Qualified Health Center (FQHC). When the vaccine is furnished in these specific settings, payment for the vaccine is based on reasonable cost.

Annual Part B deductible and coinsurance amounts do not apply for the influenza virus and 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).

Vaccination Coding

Novitas Solutions, Medicare Administrative Contractor (MAC) for Jurisdictions 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.)

• G0008 – Administration of influenza virus vaccine
• G0009 – Administration of pneumococcal vaccine
• G0010 – Administration of hepatitis B vaccine

Read “Code Change for Influenza Season 2020-2021” for guidance on how to code flu shots.

Recommendations and Updates

“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) is keeping its recommendation the same as last season: Pediatricians can use either flu shots or nasal spray flu vaccines for their patients during the 2020-2021 flu season. The AAP maintains any licensed, age-appropriate vaccine is acceptable, and everyone six months and older should be vaccinated.

Read AAP’s full statement regarding the flu vaccine for 2020-2021.

Be aware of two new influenza vaccine licensures:

• In November 2019, FDA licensed Fluzone High-Dose Quadrivalent (HD-IIV4). Fluzone High-Dose Quadrivalent is approved for use in persons aged ≥65 years. For the 2020–21 season, Fluzone High-Dose Quadrivalent is expected to replace the previously available trivalent formulation of Fluzone High-Dose (HD-IIV3). The dose volume for Fluzone High-Dose Quadrivalent (0.7 mL) is slightly higher than that of trivalent Fluzone High-Dose (0.5 mL). Fluzone High-Dose Quadrivalent, like Fluzone High-Dose, contains 4 times the amount of HA per vaccine virus in each dose compared with standard-dose inactivated influenza vaccines (60 μg per virus, versus 15 μg in standard-dose IIVs).
• In February 2020, FDA licensed Fluad Quadrivalent (aIIV4). Fluad Quadrivalent is approved for use in persons aged ≥65 years. For the 2020–21 season, both Fluad Quadrivalent and the previously licensed trivalent formulation of Fluad (aIIV3) are expected to be available. Fluad Quadrivalent, like Fluad, contains the adjuvant MF59.

Get more information regarding CDC recommendations for prevention and control of seasonal influenza.

What’s Going Around This Year?

The CDC reports the 2020–21 U.S. trivalent influenza vaccines will contain:

• A/Guangdong-Maonan/SWL1536/2019 (H1N1)pdm09-like virus (updated)
• A/Hong Kong/2671/2019 (H3N2)-like virus (updated)
• B/Washington/02/2019 (B/Victoria lineage)-like virus (updated)

The 2020–21 U.S. quadrivalent influenza vaccines will contain hemagglutinin (HA) derived from these three viruses as well as an additional influenza B viral component from the B/Yamagata lineage, which is unchanged from that included in quadrivalent influenza vaccines used during the 2019–20 season.

Compared with the 2019–20 season, the composition for 2020–21 represents updates to the influenza A(H1N1)pdm09, influenza A(H3N2), and influenza B/Victoria lineage components. These updated components will be included in both trivalent and quadrivalent vaccines.

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Stacy Chaplain

Stacy Chaplain, MD, CPC, is a development editor at AAPC. She has worked in medicine for more than 23 years, with an emphasis on education, writing, and editing since 2015. Chaplain received her Bachelor of Arts in biology from the University of Texas at Austin and her doctorate in medicine from the University of Texas Medical Branch in Galveston. She is a member of the Beaverton, Ore., local chapter.

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