Part B Insider (Multispecialty) Coding Alert

Published on Mon Nov 03, 2014 PDF

Question: We reported 90662 for a patient’s Fluzone shot and it was denied. The insurer said the patient doesn’t meet the age requirements, but we didn’t see any age listed on the code descriptor. Can you advise?

Answer: Most MACs will only cover 90662 (Influenza virus vaccine, split virus, preservative free, enhanced immunogenicity via increased antigen content, for intramuscular use) for patients age 65 and older. The higher antigen content offers increased protection to older patients, and this code is considered a high dosage of the Fluzone vaccine because it contains four times the hemagglutinin antigen per influenza strain than traditional influenza vaccines.

The vaccine may also be appropriate for people with impaired immune responsiveness, who may benefit from an increased antigen dose to more effectively stimulate the needed immune response. If that is the case with your patient and the insurer denied it, have the physician write an appeal letter to the payer explaining the unique circumstances under which he administered the Fluzone shot and why the high dose was required for your particular patient.

If your patient was under age 65 and was not immunocompromised, you should not report 90662 for Fluzone. In healthy, younger patients, the doctor would typically administer only a standard dosage of the drug, which you would report with 90658 (Influenza virus vaccine, trivalent, split virus, when administered to individuals 3 years of age and older, for intramuscular use) instead of 90662.