Part B Insider (Multispecialty) Coding Alert

Published on Fri Sep 20, 2013 PDF

New flu vaccine prices are effective retroactive to August 1.

Good news for physicians who administer flu shots — CMS seems inclined to give practices a break with some of its recent updates to the seasonal influenza vaccines pricing, which CMS announced on Sept. 13. CMS boosted payment for one code this season and reduced pay for another, according to MLN Matters article MM8433.

The Part B payment changes related to flu vaccines are as follows and went into effect on August 1:

• 90655 — Influenza virus vaccine, trivalent,  split virus, preservative free, when administered to children 6-35 months of age, for intramuscular use - $17.243 (up from $16.456 last year)
• 90656 — Influenza virus vaccine, trivalent,  split virus, preservative free, when administered to individuals 3 years and older, for intramuscular use - $12.398 (exactly the same as last year)
• 90657 — Influenza virus vaccine ,trivalent,  split virus, when administered to children 6-35 months of age, for intramuscular use - $6.022 (down from $6.023 last year)
• 90685, Influenza virus vaccine, quadrivalent, split virus, preservative free, when administered to children 6-35 months of age, for intramuscular use — $23.228 (new code this year so comparison values aren’t available)
• 90686, Influenza virus vaccine, quadrivalent, split virus, preservative free, when administered to individuals 3 years of age and older, for intramuscular use — $19.409 (new code this year so comparison values aren’t available).

For more on CMS’s flu shot pricing, visit http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM8433.pdf.