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Medicare will reimburse claims with the new influenza virus vaccine code Q2034 (influenza virus vaccine, split virus, for intra muscular use (Agriflu)), with dates of service on or after July 1, 2012 processed on or after October 1, 2012. This code is to be exclusively used for Medicare beneficiaries. The annual Part B deductible and co-insurance amounts do not apply in this regard. Physicians, non-physician practitioners and suppliers administering the flu vaccination have to accept assignment for this vaccine claim.
The CPT codes 90654 – 90658 have to be used when submitting claims to commercial insurance payers.

Other Medicare Influenza Vaccine G Codes

  • Q 2035: Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Afluria)
  • Q 2036: Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Flulaval)
  • Q 2037: Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Fluvirin)
  • Q 2038: Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Fluzone)
  • Q 2039 NOS (not otherwise specified): Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use(not otherwise specified)

Coding for the Flu Shot

  • The administration code G 0008 has to be used for Medicare patients.
  • Report the diagnosis code V04.81
  • Certain 9xxxx codes are used for Medicare patients who are covered by Medicare but are below 65 years of age. 9xxxx codes are also used for Medicare patients using a high dose, an intradermal delivery system or an intranasal delivery system. These include:
    • 90654 Influenza virus vaccine, split virus, preservative-free for intradermal use
    • 90655 Influenza virus vaccine, trivalent, preservative free, when administered to children 6 – 35 months of age, for intramuscular use
    • 90656 Influenza virus vaccine, trivalent, preservative free, when administered to individuals 3 years and older, for intramuscular use (use for Medicare flu shots using the vaccine Fluarix)
    • 90657 Influenza virus vaccine, trivalent, when administered to children 6-35 months of age, for intramuscular use
    • 90660 Influenza virus vaccine, live, for intranasal use
    • 90662 Influenza virus vaccine, trivalent, preservative free, enhanced immunogenicity via increased antigen content, for intramuscular use

Reimbursement for the New Influenza Vaccine Code

For claims with dates of service between July 1, 2012 and September 30, 2012, contractors have to consider the local pricing guidelines to determine payment rates for the influenza virus code Q 2034. This new code will have to be reimbursed to hospitals (12X and 13X), SNFs (22X and 23X), hospital-based RDFs (72X), HHA (34X) and CAHs (85X), on the basis of reasonable cost. Institutional claims with code Q 2034 (dates of service on or after July 1, 2012 and received before October 1, 2012) have to be held until system changes are implemented. Once system changes are implemented, contractors can release the claims after appending condition code 15.

Important for Providers

Enrollment in the Medicare program is compulsory for providers even if the only service they are providing Medicare beneficiaries is immunization. Enrollment should be as provider specialty type 73, Mass Immunization Roster Biller using Form CMS-8551 for individuals or Form CMS-855B for a group.