The 2012-2013 flu season was quite harsh with 700 cases of flu reported at Boston and led to the declaration of public-health emergency there. The 2014 FluView report published by the Centers for Disease Control and Prevention (CDC) indicated that the influenza activity decreased during week 8 (February 16-22), but remained prominent in the United States. However, researchers from Columbia University and the University of Cologne figured out a formula to predict the evolution of influenza for the next year as per a study published in Nature, an international weekly journal of science. They studied how the common H3N2 flu virus mutated and changed over the years since 1968. Based on those studies, they created a mathematical model that can predict how it will change in future.
The researchers monitored the viruses circulating in a particular season and their genomes and looked at how many people get affected by those viruses. The adaptive mutations that occur in the haemagglutinin protein of certain viruses were shown to increase the growth and life-time of viruses. They formulated the equation after examining every strain of the influenza virus through decades. More weight was given to the mutations that were expected to boost the virus and the strength of each strain was found by factoring in its growth rate. When they compared the estimates to different years, their formula was found to be highly accurate.
Health experts do study the virus; and how it changes over time and the frequency of changes every year to determine what flu strains need to be included in the vaccine. But what makes the new predictive model significant is that it can make the flu shot that you receive every flu season more accurate and thereby help you remain flu-resistant. Even though the study results need to be simulated before applying to real-world seasonal vaccines, researchers hope that a more precise prediction method would lead to the development of a highly protective vaccine.
Seasonal Influenza Virus Vaccination for September 2013 – July 2014
The flu season extends from September to March. The seasonal flu vaccination starts by the time the vaccine is available (normally early September) and will continue till the season ends. Universal seasonal flu vaccination is recommended by the Advisory Committee on Immunization Practices (ACIP) for anyone aged 6 months and older. However, it is quite confusing for common people and healthcare providers how commercial companies and Medicare bill for seasonal vaccination for influenza, especially when Obamacare is already effective. Since this vaccination comes under preventive care service, this is covered by almost all state insurance exchange plans and no deductible, co-pay or co-insurance is there as per the Affordable Care Act.
Though both types of carriers bill this vaccination differently, there must be two medical billing codes for this service – a code for the flu vaccine itself and a code for its administration. Majority of carriers including Medicare provide reimbursement for both codes (though some do not pay an amount separately for administration). In addition to these codes, diagnosis code and modifier (in certain cases) are required for billing the vaccination correctly. Let’s take a look at these codes for the 2013-2014 season.
Vaccination Codes
There are two types of vaccination codes, HCPCS Q-codes and CPT codes (9xxxx). Normally, the former is for Medicare patients and the latter is for non-Medicare patients. However, CPT codes are used for Medicare patients in certain cases.
CPT codes
- 90653: Influenza vaccine, inactivated, subunit, adjuvanted, for intramuscular use
- 90654: Influenza virus vaccine, split virus, preservative-free, for intradermal use
- 90655: Influenza virus vaccine, trivalent, split virus, preservative free, when administered to children 6-35 months of age, for intramuscular use
- 90656: Influenza virus vaccine, trivalent, split virus, preservative free, when administered to individuals 3 years and older, for intramuscular use
- 90657: Influenza virus vaccine, trivalent, split virus, when administered to children 6-35 months of age for intramuscular use
- 90660: Influenza virus vaccine, trivalent, live, for intranasal use
- 90661: Influenza virus vaccine, derived from cell cultures, subunit, preservative and antibiotic free, for intramuscular use
- 90662: Influenza virus vaccine, split virus, preservative free, enhanced immunogenicity via increased antigen content, for intramuscular use
- 90672: Influenza virus vaccine, quadrivalent, live, for intranasal use
- 90673: Influenza virus vaccine, trivalent, derived from recombinant DNA (RIV3), hemagglutnin (HA) protein only, preservative and antibiotic free, for intramuscular use
- 90685: Influenza virus vaccine, quadrivalent, split virus, preservative free, when administered to children 6-35 months of age, for intramuscular use
- 90686: Influenza virus vaccine, quadrivalent, split virus, preservative free, when administered to individuals 3 years of age and older, for intramuscular use
- 90687: Influenza virus vaccine, quadrivalent, split virus, when administered to children 6-35 months of age, for intramuscular use
- 90688: Influenza virus vaccine, quadrivalent, split virus, when administered to individuals 3 years of age and older, for intramuscular use
HCPCS codes
- 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 older, for intramuscular use (Afluria)
- Q2036: Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Flulaval)
- Q2037: Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Fluvirin)
- Q2038: Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Fluzone)
- Q2039: Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (not otherwise specified)
CPT code 90673 replaced Q2033 (Influenza Vaccine, Recombinant Haemagglutinin Antigens, for Intramuscular Use (Flublok)) on January 1, 2014
Administration Codes
- 90471: Immunization administration (includes percutaneous, intradermal, subcutaneous or intramuscular injections); 1 vaccine (single or combination vaccine/toxoid.) If giving two or more vaccines at the same visit, use 90471 for the first and 90472 for each additional vaccine administration
- 90473: Immunization administration by intranasal or oral route; 1 vaccine (single or combination toxoid.) If giving two nasal/oral vaccines, use 90473 for the first and 90474 for each additional vaccine administration
- 90460: Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; first vaccine/toxoid component
- +90461: Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; each additional vaccine/toxoid component
- G0008: Administration code for Medicare
Diagnosis Code and Modifier
The ICD-9 diagnosis code V04.81 (Prophylactic vaccination and inoculation against influenza) should be used for influenza vaccination. If Pneumococcus and Influenza vaccinations are given on the same date, then V06.6 (ICD-9 code) should be used. While giving a vaccination at a time when seeing that same patient for a medically necessary office visit, use a modifier 25 on the E/M code and map to a diagnosis code that explains the reason for the medically necessary office visit.
Commercial Codes for Influenza Vaccine Products for the 2013–2014 Influenza Season
| Trade Name | How Supplied | Age Group | Product Code |
| Afluria (IIV3) | 0.5 mL (single-dose syringe)
5.0 mL (multi-dose vial) |
9 years & older | 90656
90658 |
| Fluarix (IIV3) | 0.5 mL (single-dose syringe) | 3 years & older | 90656 |
| Fluarix (IIV4) | 0.5 mL (single-dose syringe) | 3 years & older | 90686 |
| FluLaval (IIV3) | 5.0 mL (multi-dose vial) | 3 years & older | Q2036(Medicare) |
| FluLaval (IIV4) | 5.0 mL (multi-dose vial) | 3 years & older | 90688 |
| FluMist (LAIV4) | 0.2 mL (single-use nasal spray) | 2 through 49 years | 90672 |
| Fluvirin (IIV3) | 0.5 mL (single-dose syringe) 5.0 mL (multi-dose vial) |
4 years & older | 90656 Q2037(Medicare) |
| Flucelvax (ccIIV3) | 0.5 mL (single-dose syringe) | 18 years & older | 90661 |
| Flublok (RIV3) | 5.0 mL (single-dose vial) | 18 through 49 years | 90673 Q2033(Medicare) |
| Fluzone (IIV3) | 0.25 mL (single-dose syringe) 0.5 mL (single-dose syringe) 0.5 mL (single-dose vial) 5.0 mL (multi-dose vial), 6 through 35 months 5.0 mL (multi-dose vial), 3 years and older |
6 through 35 months 3 years & older 3 years & older 6 through 35 months 3 years & older |
90655 90656 90656 90657 90658 |
| Fluzone (IIV4) | 0.25 mL (single-dose syringe) 0.5 mL (single-dose syringe) 0.5 mL (single-dose vial) |
6 through 35 months 3 years & older 3 years & older |
90685 90686 90686 |
| Fluzone High-Dose (IIV3) | 0.5 mL (single-dose syringe) | 65 years & older | 90662 |
| Fluzone Intradermal (IIV3) | 0.1 mL (single-dose microinjection system) | 18 through 64 years | 90654 |
Note: On August 6, 2010, the ACIP (Advisory Committee on Immunization Practices) recommended that Afluria not be used in children younger than age 9 years. Afluria may be considered for a child age 5 through 8 years at high risk for influenza complications, after risks and benefits have been discussed with the parent or guardian, If no other age-appropriate IIV is available; Afluria should not be used in children younger than age 5 years. This recommendation is relevant for the 2013–2014 influenza season.
It is very important for healthcare providers to check with the patients’ insurance plans which vaccine and administration code they would reimburse for. Since Medicare reimbursement rates change periodically, it is quite imperative to stay updated too. Giving focus to both patient care and billing procedures is relatively challenging for physicians as it may affect their productivity and revenue. Seeking help from a professional medical billing and coding company that offers family practice billing service is a better option to streamline the billing process and receive the due reimbursement in time. Next year, family practice physicians may also provide highly protective vaccine owing to the new predictive model and improve the quality of their services too.
