Flu Vaccine Codes and Payments Effective Aug. 1
Is your billing office ready for the 2022-2023 influenza season?
For the 2022-2023 influenza season, the Centers for Disease Control and Prevention (CDC) recommends everyone 6 months of age and older be vaccinated against the flu “ideally by the end of October.” This advice has not changed from previous years, but the Medicare Part B payment allowances for the flu vaccines have changed.
Flu Vaccination Coding and Billing
For the most part, Medicare Part B payment allowances increased slightly for the 2022-2023 flu season, as shown in Table A.
Table A: Comparison of CPT® code and Medicare Part B payment allowances for 2021-2022 and 2022—2023 flu seasons
|Code||Vaccine Name||Payment Allowance|
|90662||Fluzone High-Dose Quadrivalent||$65.261||$69.941|
|90674||Flucelvax Quadrivalent (Pres Free)||$29.940||$32.278|
|90685||Fluzone Quadrivalent 0.25ml (Pres Free)|
Afluria Quadrivalent 0.25ml (Pres Free)
|90686||Fluarix Quadrivalent (Pres free)|
Flulaval Quadrivalent (Pres Free)
Fluzone Quadrivalent (Pres Free)
Afluria Quadrivalent (Pres Free)
|90687||Fluzone Quadrivalent 0.25ml|
Afluria Quadrivalent 0.25ml
|90694||Fluad Quadrivalent (2022-2023 – Pres Free)||$66.426||$71.682|
The Medicare Part B payment allowance limits for influenza vaccines are 95 percent of the average wholesale price (AWP) except when the vaccine is furnished in a hospital outpatient department, rural health clinic (RHC), or federally qualified health center (FQHC), where payments are based on reasonable cost.
It’s important to note that the annual flu season runs Aug. 1 through July 31, so it’s possible for a Medicare patient to receive two fully-covered flu vaccines in one calendar year. For example, if a patient was vaccinated for the flu on Jan. 5, 2022, and again on Aug. 29, 2022, Medicare would pay both claims.
As always, annual Part B deductible and coinsurance amounts do not apply for influenza virus vaccinations.
Medicare instructs to report ICD-10-CM code Z23 Encounter for immunization on the claim, along with the administration code G0008 Administration of influenza virus vaccine. Unlike the vaccine product pricing, which is updated Aug. 1, the pricing for G0008 is effective Jan. 1 through Dec. 31. The locality-adjusted 2022 Medicare Physician Fee Schedule (MPFS) payment rates for influenza, pneumococcal, and hepatitis B vaccine administration file is available for download from the CMS website.
Check Claims for Proper Payment
Medicare Administrative Contractors (MACs) are not expected to update their systems with the 2022-2023 flu vaccine payment allowances by the Aug. 1 effective date and are required to reprocess claims paid at last season’s prices by Nov. 1, unless granted an extension.
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