CMS Creates Several New Influenza Vaccine Product Codes

Inappropriate Use of Old Codes Will Result in Nonpayment as of Jan. 1

November 09, 2010 04:30 pm Sheri Porter

CMS has created five new Healthcare Common Procedure Coding System, or HCPCS, codes for physicians to consider when reporting seasonal influenza immunizations they give their patients. Beginning Jan. 1, physicians should use these "Q" codes when administering products previously reported with CPT code 90658.

The new HCPCS codes and the specific products for which they should be used are:

  • Q2035 for Afluria,
  • Q2036 for Flulaval,
  • Q2037 for Fluvirin,
  • Q2038 for Fluzone, and
  • Q2039 for influenza virus vaccine, split-virus, when administered to individuals 3 years of age and older -- for intramuscular use (not otherwise specified).

Certain other vaccine codes still are valid 2010-2011 flu vaccine codes, so physicians should use CPT codes 90655-90657, 90660 and 90662 when they use vaccine products represented by those codes.

According to Cynthia Hughes, C.P.C., an AAFP coding specialist, CMS has deemed CPT code 90658 a "nonpayable" code.

"Any physician who uses CPT code 90658 for dates of service after Dec. 31 will see that portion of the claim denied," said Hughes. "If practices start right away, they'll have the rest of this month and next to make changes to their billing forms and programs," she added.

Hughes attributed the coding changes to wording in the final 2011 Medicare Physician Fee Schedule(edocket.access.gpo.gov). The rule allows Medicare to base vaccine payments on the average wholesale price of each vaccine.

"Medicare has assigned 'Q' codes to each individual product this year to account for variances in manufacturers' pricing of their influenza vaccine product," said Hughes, adding that this step should help ensure physicians are paid fairly for products that may have significant cost differences.

Hughes noted that private insurers may make independent decisions about whether or not to adopt CMS' coding changes.


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