Wiki Medicare and flu vaccine

It depends on which vaccination is given; 90658/Q codes are not the only codes that may apply. Check the CMS Quick Reference for Medicare Immunization Billing and find the correct code for what was administered. If it is one that would fall under 90658 per CPT guidelines, convert it to the correct Q code.
 
For accurately coding Flu vaccine you need to first confirm if the vaccine is preservative free or not.

If it is preservative free then you need to use CPT 90656 and G0008 for non-Medicare as well as for Medicare patients.

If the vaccine contains preservatives then need to use CPT 90658 / 90471 for other insurance & for Medicare Q codes are available such as Q2034, Q2035, Q2036, Q2037, Q2038 & Q2039 depending upon the brand of Flu vaccine. For e.g if provider uses Fluzone with preservative then one need to use CPT 90658 for other insurance & Q2038 for Medicare.
 
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