In my opinion,
I would coded this scenario for Medicare patient as :
90713 - V04.0
90471 - V04.0
90658 - V04.81
G0008 - V04.81
As per definition CPT 90471 says Immunization administration 1 vaccine (single or combination vaccine/toxoid) & G0008 clearly says Administration of influenza virus vaccine.
I don't think there is need of modifier 59 for any of above CPTs as they are clearly distinguished by their deffinition. As per our observation, we have also submitted claim in same manner but till not received any denial.
All the Best !
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