J4 MAC Locally Prices Fluzone

Although Fluzone® high-dose influenza virus vaccine, CPT® code 90662 Influenza virus vaccine split virus, preservative free, enhanced immunogenicity via increased antigen content for intramuscular use, was included in the Average Sales Price (ASP) National Drug Code (NDC)-HCPCS Crosswalk, a national payment will not be published by the Centers for Medicare & Medicaid Services (CMS) until later this year. Until the national payment is published, Medicare contractors have been instructed to price the code locally.

TrailBlazer Health announced Sept. 9 that, effective for dates of service on or after July 1, 2010, the payment allowance for CPT® code 90662 is $29.21. TrailBlazer is the Medicare administrative contractor (MAC) for jurisdiction 4, which represents Colorado, New Mexico, Oklahoma, and Texas.

As applicable to influenza vaccines, the payment allowance is based on 95 percent of the Average Wholesale Price (AWP).

The ASP NDC-HCPCS Crosswalk is available on the CMS 2010 ASP Drug Pricing Files web page. Click July 2010 ASP NDC-HCPCS Crosswalk under the Downloads section.

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