As Flu Season Continues Review Claim Reimbursement for Vaccinations

If your office is administering Influenza Virus and Pneumococcal vaccinations, you should review the following information to insure you are submitting the correct diagnosis and procedure codes to receive the proper claim reimbursement. The vaccine procedure code should be chosen based on the description of the drug and the age of the patient. Each vaccine code should be billed with the appropriate administration code as well.

flu vaccination billing                                              

The following procedure and diagnosis codes are used for influenza virus vaccinations: 

CPT/HCPCS Code

Description

90654

Influenza virus vaccine, split virus, preservative free, for intradermal use

90655

Influenza virus vaccine, split virus, preservative free, for children 6-25 months of age, for intramuscular use

90656

Influenza virus vaccine, split virus, preservative free, for use in individuals 3 years and above, for intramuscular use

90657

Influenza virus vaccine, split virus, for children 6-25 months of age, for intramuscular use

90660

Influenza vaccine, live, for intranasal use

90662

Influenza virus vaccine, split virus, preservative free, enhanced immunogenicity via increased antigen content, for intramuscular use. (High Dose)

Q2034

Influenza virus vaccine, split virus, for intramuscular use (Agriflu)

Q2035

Influenza virus vaccine, split virus, when administered to individuals 3 years of age and above, for intramuscular use (Afluria)

Q2036

Influenza virus vaccine, split virus, when administered to individuals 3 years of age and above, for intramuscular use (Fluluval)

Q2037

Influenza virus vaccine, split virus, when administered to individuals 3 years of age and above, for intramuscular use (Fluvirin)

Q2038

Influenza virus vaccine, split virus, when administered to individuals 3 years of age and above, for intramuscular use (Fluzone)

G0008

Administration of influenza virus vaccine

 

Diagnosis Code

Description

V04.81

Influenza vaccination with dates of service 10/1/2003 and later

V06.6

Influenza and pneumococcal vaccination (Report this code when the purpose of the visit was to receive both vaccinations during the same visit)

The following procedure and diagnosis codes are used for pneumococcal vaccinations:

CPT/HCPCS Code

Description

90669

Pneumococcal conjugate vaccine, polyvalent, for children under 5 years, for intramuscular use

90670

Pneumococcal conjugate vaccine, 13-valent, for intramuscular use

90732

Pneumococcal polysaccharide vaccine, 23-valent, adult or immunosuppressed patient dosage, for use in individuals 2 years or older, for subcutaneous or intramuscular use

G0009

Administration of the pneumococcal vaccine when no physician fee schedule service on the same day

 

Diagnosis Code

Description

V03.82

Pneumococcal vaccination

V06.6

Pneumococcal and influenza vaccination (Report this code when the purpose of the visit was to receive both vaccinations during the same visit)

CMS has available on it's website numerous resources to assist providers:

Facts on Influenza, Pneumococcal, and Hepatitis B Immunizations: http://www.cms.gov/Medicare/Prevention/Immunizations/index.html?redirect=/Immunizations/

The 2012- 2013 Immunizers’ Question & Answer Guide : http://www.cms.gov/Medicare/Prevention/Immunizations/Downloads/2012-2013_Flu_Guide.pdf

Current pricing information: http://www.cms.gov/McrPartBDrugAvgSalesPrice/10_VaccinesPricing.asp#TopOfPage