Ignore Administration Route for Correct Medicare Vaccine Billing
Question: We billed 90672 with administration code 90473 for administering a dose of FluMist Quad and got denied. The denial stated, in part, that “the administration method and drug must be reported to adjudicate this service.” As 90672 is administered intranasally, surely 90473 is the correct administration code to use as it specifies the appropriate method of administration for FluMist. What did we do wrong? New York Subscriber Answer: If this was a Medicare patient, the issue is likely with an incorrect administration code. While 90473 (Immunization administration by intranasal or oral route; 1 vaccine (single or combination vaccine/toxoid)) does specify that the route of administration was intranasal, which would seem to be appropriate for 90672 (Influenza virus vaccine, quadrivalent, live (LAIV4), for intranasal use) as it is administered intranasally, the administration code is incorrect for Medicare billing. Instead, you should use G0008 (Administration of influenza virus vaccine). Like the other Medicare vaccine administration codes, this HCPCS code does not specify any particular administration route. Instead, it only indicates the kind of vaccine your practitioner administered, which, in this case, was an influenza vaccine.
