Oncology & Hematology Coding Alert

Question: What is the new code introduced in 2015 for the quadrivalent influenza vaccine? Does Medicare cover for influenza vaccines in 2015?

New Jersey Subscriber

Answer: The new 2015 CPT® code 90630 (Influenza virus vaccine, quadrivalent [IIV4], split virus, preservative free, for intradermal use) is for the quadrivalent, split virus, preservative free, intradermal injection. 

Quadrivalent means the vaccine protects against four types of influenza virus. Although approval from the FDA is pending, providers can still administer the vaccine. 

Check with your carrier: Some carriers may not cover the vaccine pending approval, but you should still report the procedure as an important step in the eventual approval for coverage. Check with the carrier to verify their requirements. You should document necessity to establish why the provider chose this vaccine over other choices.

Keep documentation: Make sure you have the following parameters listed in your documentation before coding for flu vaccines: Age of the patient, active/inactivated vaccine, recombinant or live attenuated vaccine; tri- or quadrivalent vaccine preservative (thimerosol, Hg) free vaccine, high-dose, and route of administration.

Also: Don’t forget to capture vaccine administration CPT® codes 90471 (Immunization administration [includes percutaneous, intradermal, subcutaneous, or intramuscular injections]; 1 vaccine [single or combination vaccine/toxoid]) -+90474 (Immunization administration by intranasal or oral route; each additional vaccine [single or combination vaccine/toxoid] [List separately in addition to code for primary procedure]), in addition to the vaccine codes.

Medicare: Medicare payment rates for seasonal vaccines are effective Aug. 1, 2014 through July 31, 2015. Medicare continues to cover many seasonal influenza vaccines without coinsurance or co-payment deductions. 

Medicare local claims contractors will determine whether the charges raised on your claims are reasonable and necessary for payment. Also, payment for the HCPCS code Q2039 (Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use [not otherwise specified]) is a local contractor discretion.

Read more on: http://www.cdc.gov/flu/protect/vaccine/vaccines.htm