Medicare Billing for Seasonal Flu Vaccines

As you know, Medicare began covering annual influenza immunizations in 1993 for all Medicare beneficiaries. Medicare covers both the costs of the vaccine and its administration by recognized providers. There is no coinsurance or co-payment applied to this benefit, and a beneficiary does not have to meet his or her deductible to receive this benefit.

As we head into winter and flu season, flu shots are on the rise; even drugstore chains are offering them on-site to Medicare beneficiaries. Providers need to make sure they are submitting proper claims, with correct CPT-4 codes, for any flu vaccines administered to Medicare patients. As of January 1, 2011, CPT code 90658 was discontinued for the seasonal influenza vaccine; the correct code(s) to use are: Q2035, Q2036, Q2037, Q2038, and Q2039. In addition to the influenza CPT code above, providers must also submit the administration code (G0008). Below are some useful links to a quick reference guide & payment allowances for the seasonal flu vaccine.

Payment allowances for 09/30/2011 through 08/31/2012
Quick Reference Information: Medicare Immunization Billing

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