This is the flu season. If you are not sick, there is a good chance some of your family, friends, or acquaintances are. The Centers for Disease Control and Prevention (CDC) warned providers about the rise of "influenza A (H3N2)," affecting more patients and leading to more hospitalizations.
Influenza vaccinations have been in the spotlight to help with prevention, so be sure you know the right codes and rules to apply.
90756 (Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, antibiotic free, 0.5 mL dosage, for intramuscular use).
If you code for flu vaccinations regularly, then you may know that these codes aren't entirely new. Code 90756 was released to the AMA website on July 1, 2017, with an effective date of Jan. 1, 2018. But some payers started accepting the code for the vaccine (Seqirus Flucelvax Quadrivalent) prior to Jan. 1, 2018. This code has a payment allowance of $22.793.
In case your payer did not accept this code until Jan. 1 dates of service, you may need to check their policies to see whether you should report 90749 (Unlisted vaccine/toxoid) or Q2039 (Influenza virus vaccine, not otherwise specified) for those earlier dates instead.
Tip: You may continue to use CPT® code 90674 to best describe preservative- and antibiotic-free Flucelvax Quadrivalent pre-filled syringes.
Code 90682 (with a payment allowance of $46.313) goes back even more, debuting on the AMA website on July 1, 2016. It became effective Jan. 1, 2017. However, 2018 is the first year it appears in the CPT® book. This code applies to Protein Sciences Flublok Quadrivalent (preservative free).
You should report three components for each vaccination claim — administration, vaccine supply, and diagnosis code.
Medicare Part B provides preventive coverage for influenza once per season. Use G0008 (Administration of influenza virus vaccine) to report administration services for these preventive vaccines. There's no coinsurance/co-payment, and a beneficiary does not have to meet her deductible to receive this benefit.
Remember: Other payers may require you to use administration codes from CPT® code range 90460-90474. ICD-10-CM code Z23 (Encounter for immunization) identifies the reason for the service.
CMS annually updates the Medicare HCPCS and CPT® codes and payment allowances for personal flu and pneumococcal vaccines. The payment allowance limits for such vaccines are 95 percent of the Average Wholesale Price (AWP). However, when administered in the hospital outpatient department, the vaccine is paid based on reasonable cost.
Get details of 2017-2018 payment allowances and effective dates for all influenza vaccines on the CMS Seasonal Influenza Vaccines Pricing website.
Are you facing challenges reporting flu vaccines this year?
Barnali is a medical coding and billing writer at TCI who has worked in the healthcare industry since 2009. She holds a master's degree in English literature and a diploma in advertising and marketing. She enjoys writing about ICD-10 and Medicare compliance.
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