Influenza Vaccine Resources

AAFP Offers Pointers on Getting Paid for Providing Flu Vaccine to Patients

November 09, 2011 04:40 pm News Staff

All across the country, influenza vaccinations are in full swing, and the AAFP wants to ensure that family physicians who provide this service to their patients have the information they need to get paid for the vaccine products they use, as well as for administering the vaccines.

To that end, Cynthia Hughes, C.P.C., an AAFP coding and compliance specialist is calling attention to Medicare's online posting of seasonal influenza vaccine prices that lists Medicare payment allowances for dates of service between Sept. 1, 2011, and Aug. 31, 2012. That list consists of

  • Q2035, Afluria - $11.54,
  • Q2036, Flulaval - $8.78,
  • Q2037, Fluvirin - $13.65,
  • Q2038, Fluzone - $13.31, and
  • Q2039, Not otherwise specified - locally priced.

In addition, payment allowances for the following flu vaccine administration CPT codes are

  • 90654 - $18.38,
  • 90655 - $15.71,
  • 90656 - $12.38,
  • 90657 - $6.65,
  • 90660 - $22.32, and
  • 90662 - $30.92.

According to Hughes, the national average payment for administration of flu vaccine in an office setting is $23.10. The Medicare allowable amount for each of the vaccine administration codes is the same as the amount allowed for CPT code 90471, which is the code for immunization administration provided to adults or provided to children without physician counseling, she added. Doses of a childhood vaccine series given after the first dose do not require counseling.

Other pertinent influenza vaccine administration codes include

  • G0008 for Medicare patients receiving the influenza vaccine,
  • 90471 for other adults and children who receive the vaccine without physician counseling, and
  • 90460 for children as old as age 18 years who receive physician counseling with vaccine administration.

In addition, the CDC recently put together vaccine-related information that could prove useful to physicians. For example, in its Pediatric Influenza Vaccine Price List(www.cdc.gov), the agency provides pediatric age indications by vaccine product. Pricing information that is pertinent to the Vaccines for Children program was last updated on Nov. 2.

Hughes also urged family physicians to take a look at the CDC's guidance(www.cdc.gov) on flu vaccine dosing for children. According to a recommendation made by the CDC's Advisory Committee on Immunization Practices, children ages 6 months through 8 years who did not receive at least one dose of the 2010-11 seasonal influenza vaccine should receive two doses of the 2011-12 seasonal influenza vaccine.

Lastly, Hughes pointed out diagnosis codes of which physicians should be aware, including

  • V04.81 for influenza immunizations,
  • V06.6 for Medicare patients receiving both the pneumococcus and influenza vaccines, and
  • V20.2 for vaccine administered in conjunction with a well-child visit.

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