Anesthesia Coding Alert

And don’t forget to add those administration codes.

On Aug. 13, 2025, the Centers for Medicare & Medicaid Services (CMS) posted the Medicare Part B payment allowance limits for the 2025-2026 season influenza (flu) vaccines. The new rates are effective Aug. 1, 2025, through July 31, 2026. Changes from last season include rate increases and one new vaccine code.

The three recommended vaccines are:

• Fluzone high-dose trivalent inactivated flu vaccine
• Flublok trivalent recombinant flu vaccine
• Fluad trivalent adjuvanted inactivated flu vaccine

If these vaccines aren’t available, providers should use the standard-dose flu vaccine, according to CMS.

Make Note of These Flu Vaccine Codes and Payment Allowances

The CPT^® codes for the 2025-2026 season flu vaccine products and payment allowances are as follows:

Source: CMS (8/13/25)

Medicare Part B payment for vaccines is 95 percent of the average wholesale price except in hospital outpatient departments, hospital-based rural health clinics, and federally qualified health clinics, where payment is based on reasonable cost. Payments are also geographically adjusted.

Also, remember to bill the administration code — 90471 (Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 vaccine (single or combination vaccine/toxoid)) for commercial payers or HCPCS Level II code G0008 (Administration of influenza virus vaccine) for Medicare, with ICD-10-CM code Z23 (Encounter for immunization) on the claim.

Medicare Part B covers the seasonal flu shot per season (Aug. 1 – July 31), not per calendar year, so it’s conceivable for a patient to get a flu shot twice in a calendar year and for Medicare to pay for both. Copayments, coinsurance, and deductibles do not apply.

Know That Medicare Pays More for In-Home Vaccines

As of Jan. 1, 2024, providers who administer the flu vaccine to Medicare patients in their homes may bill an additional fee of approximately $40 (in addition to the standard administration fee) when the following requirements are met:

• The patient has difficulty leaving their home for a medical reason (e.g., illness, injury, condition) or has another legitimate reason for not being able to leave their home (e.g., lack of transportation).
• The provider documents in the patient’s medical record why the patient cannot leave their home to be vaccinated, and this is captured on the claim with appropriate ICD-10-CM coding.
• The additional payment may not be billed for vaccines administered to patients residing in Medicare skilled nursing facilities and Medicaid nursing facilities.
• The additional payment may be billed once per patient per date of service, up to a maximum of five vaccine administration services when fewer than 10 Medicare patients get a vaccine dose on the same day at the same group home.
• When 10 or more Medicare patients receive a vaccination on the same day at the same group living home, only one additional payment may be billed.
• The additional payment for an in-home vaccine does not apply if the purpose of the visit is for another billable service such as an evaluation and management service.

For the additional payment, you’ll bill HCPCS Level II code M0201 (Administration of pneumococcal, influenza, hepatitis b, and/or covid-19 vaccine inside a patient’s home; reported only once per individual home per date of service when such vaccine administration(s) are performed at the patient’s home).

This additional payment applies to COVID-19, hepatitis B, and pneumococcal vaccines, as well.

Renee Dustman, Managing Editor, Content & Editorial, APPC
(A version of this article first appeared on the AAPC Knowledge Center blog)