Wiki Flu shots

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Payers have a 1 unit maximum on these codes, so you won't be able to get payment for two units unless you appeal. Are your providers administering two injections or just combining the doses for a single? If they are just combining two vials for one immunization, that is a drug packaging issue and shouldn't affect the coding. It would be most appropriate to code for the service that was actually given - whether the dose was drawn from a single vial or from two would not be relevant to that.
 
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we haven't done anything yet, but we ran out of the .5ML but we have plenty .25 however in our experience, 90685 doesn't get paid for older kids.
 
It would be appropriate to bill 90686 since that code applies to a 0.5 ml dosage for ages 3 and up. You would want to update your NDC data in box 24 that links to CPT 90686 to reflect the actual products that were used.

I posted the link from the CDC website re: seasonal flu vaccines and the appropriateness of administering a pediatric dose to older children.

https://www.cdc.gov/flu/about/qa/vaxadmin.htm

"If inactivated influenza vaccine presentations for persons 3 years of age and older are not available, can a high-risk older child or adult receive the pediatric product (thimerosal preservative-free 0.25 ml dose) as long as they are given 0.5 mL?
Flu vaccine is available and recommended for almost everyone 6 months of age and older. If an adequate supply of adult formulation is available, CDC does not recommend that providers use pediatric formulations to vaccinate adults.

If there is not an adequate supply of adult formulation, providers may choose to administer pediatric presentations such as manufacturer-filled syringes (0.25 mL). Two manufacturer-filled syringes (0.25 mL) are needed to provide the correct dose (0.5 mL) for persons 3 years of age and older. Two separate injections should be administered. Providers should never attempt to transfer vaccine from one syringe to another for the purpose of administering only one injection. This is considered off-label use."

Hope that helps!

Sharon Gall, CPC
 
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