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.
The following procedure and dianosis 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
Coding Hint: Based on CCI edits, when performing an unrelated E/M service on the same date as the vaccination, append a “25” modifier to your E/M service procedure code to prevent denials of your immunization service.
