Immunization providers in various clinical and other settings are focusing on the safe administration of influenza vaccines. This has become even more significant as the COVID-19 pandemic continues to be a public health emergency. The Centers for Disease Control and Prevention (CDC) announced that this season’s flu vaccines were updated to deal with the viruses expected to be circulating in the U.S. Immunization providers need to be knowledgeable about flu vaccine products, how to code and bill vaccinations, and payer rules and timelines. In addition to updating their billing systems with the 2020 Average Sales Price (ASP) Drug Pricing Files, they need to follow the CDC’s guidance on safely administering vaccines during the COVID-19 pandemic. Partnering with an experienced medical billing and coding company can ensure accurate coding and billing for influenza vaccine which is critical for appropriate reimbursement.

The typical symptoms of influenza are fever, cough, sore throat, shortness of breath, runny nose, fatigue, body aches, diarrhea and vomiting. According to a CDC statement issued on August 30, flu vaccines for 2020-2021 will contain 8 viruses:

Trivalent (three-component) egg-based vaccines are recommended to contain:

  • A/Guangdong-Maonan/SWL1536/2019 (H1N1)pdm09-like virus (updated)
  • A/Hong Kong/2671/2019 (H3N2)-like virus (updated)
  • B/Washington/02/2019 (B/Victoria lineage)-like virus (updated)

Quadrivalent (four-component) egg-based vaccines are recommended to contain:

  • The three above-mentioned viruses as well as B/Phuket/3073/2013-like (Yamagata lineage) virus.

Cell- or recombinant-based vaccines are recommended to contain:

  • A/Hawaii/70/2019 (H1N1)pdm09-like virus (updated)
  • A/Hong Kong/45/2019 (H3N2)-like virus (updated)
  • B/Washington/02/2019 (B/Victoria lineage)-like virus (updated)
  • B/Phuket/3073/2013-like (Yamagata lineage) virus

The CDC lists the vaccine options for this season as:

  • Standard dose flu shots
  • High-dose shots for people 65 years and older
  • Shots made with adjuvant for people 65 years and older
  • Shots made with virus grown in cell culture (no eggs are involved in the production)
  • Shots made using a vaccine production technology (recombinant vaccine) that do not require having a candidate vaccine virus (CVV) sample to produce
  • Live attenuated influenza vaccine (LAIV) – A vaccine made with attenuated (weakened) live virus that is given by nasal spray.

The CDC stresses that it is especially important that people at high risk for flu complications get vaccinated to decrease their risk of severe flu illness. People who are at high risk from flu may also face a higher risk from COVID-19 and the CDC strongly recommends that such people get vaccinated this year. While getting a flu vaccine will not protect against COVID-19, it can reduce the risk of flu illness, hospitalization and death.

CPT codes for the 2020-2021 Influenza Vaccine Products

CPT Code Descriptor Manufacturer Product
90653 Influenza vaccine, inactivated (IIV), subunit, adjuvanted, for intramuscular use Seqirus Fluad
90694 Influenza virus vaccine, quadrivalent (aIIV4), inactivated, adjuvanted, preservative free, 0.5 mL dosage, for intramuscular use Seqirus Fluad Quadrivalent
90662 Influenza virus vaccine (IIV), split virus, preservative free, enhanced immunogenicity via increased antigen content, for intramuscular use Sanofi Pasteur Fluzone High-Dose Quadrivalent
90672 Influenza virus vaccine, quadrivalent, live (LAIV4), for intranasal use MedImmune FluMist Quadrivalent
90674 Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage, for intramuscular use Seqirus Flucelvax Quadrivalent
90682 Influenza virus vaccine, quadrivalent (RIV4), derived from recombinant DNA, hemagglutinin (HA) protein only, preservative and antibiotic free, for intramuscular use Sanofi Pasteur Flublok Quadrivalent
90685 Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, 0.25 mL dosage, for intramuscular use Sanofi Pasteur Seqirus Fluzone Quadrivalent 0.25ml Afluria Quadrivalent 0.25ml
90686 Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, 0.5 mL dosage, for intramuscular use GlaxoSmithKline Sanofi Pasteur Seqirus Fluarix Quadrivalent Flulaval Quadrivalent Fluzone Quadrivalent Afluria Quadrivalent
90686 Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, 0.5 mL dosage, for intramuscular use GlaxoSmithKline Sanofi Pasteur Seqirus Fluarix Quadrivalent Flulaval Quadrivalent Fluzone Quadrivalent Afluria Quadrivalent
90687 Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.25 mL dosage, for intramuscular use Sanofi Pasteur Seqirus Fluzone Quadrivalent 0.25ml Afluria Quadrivalent 0.25ml
90688 Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.5 mL dosage, for intramuscular use Sanofi Pasteur Seqirus Fluzone Quadrivalent Afluria Quadrivalent
90756 Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, antibiotic free, 0.5 mL dosage, for intramuscular use Seqirus Flucelvax Quadrivalent

The CDC notes that for the 2020-2021 flu season, manufacturers are expected to supply 194-198 million doses of flu vaccine, which is higher than the 175 million dose record set during the 2019-2020 flu season.

Billing for Immunizations

Here are some tips for billing immunizations:

  • Set up all your practice systems for correct coding and billing.
  • Bill the correct CPT code for the influenza vaccines in use this season.
  • Report both the administration of influenza vaccine and the vaccine product code.
  • As there are different codes for different circumstances, take care to report the most suitable immunization administration code for the patient encounter.
  • Know and follow payer guidelines on submitting NDCs, CPT codes and modifiers to prevent denials.
  • To specify a diagnosis of encounter for immunization, append ICD-10 code Z23 Encounter for immunization to the vaccine code and the administration code.
  • Z23 would be a secondary code if the immunization is given during a routine preventive health care examination. The routine examination, such as a well-woman exam, would be the primary code.
  • Do not bill the visit if vaccination is the only service provided. When a separate and significant service is provided along with a vaccination, both the visit and the vaccination services can be billed.

Medical billing services are available to help physicians maximize vaccination reimbursement. In addition to staying up-to-date on the season’s vaccine products and codes, experienced coders in medical billing companies are knowledgeable about payer rules and requirements and can ensure accurate claim submission.