How to code flu shots correctly

New flu shot codes and payment allowances go into effect each year on Aug. 1 for Medicare, allowing vaccination efforts to begin as soon as the seasonal influenza vaccine is available. To determine the correct vaccine code, you need to know the following:

• What vaccine was provided, including the brand,
• Whether the product was trivalent or quadrivalent,
• Whether the product was preservative free.

For example, here are two commonly used codes and their associated products:

Code

Labeler name

Drug name

Payment allowance

90686, “Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, 0.5 mL dosage, for intramuscular use.”

GlaxoSmithKline

Sanofi Pasteur

Seqirus

Fluarix quadrivalent (2019/2020) (preservative free)
Flulaval quadrivalent (2019/2020) (preservative free)
Fluzone quadrivalent (2019/2020) (preservative free)
Afluria quadrivalent (2019/2020) (preservative free)

$19.03

90688, “Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.5 mL dosage, for intramuscular use.”

GlaxoSmithKline

Sanofi Pasteur

Seqirus

Flulaval quadrivalent (2019/2020)
Fluzone quadrivalent (2019/2020)
Afluria quadrivalent (2019/2020)

$17.84

For a full list of current codes and payment allowances for flu vaccines billed to Medicare Part B, see Seasonal Influenza Vaccines Pricing. Codes not included in the full list likely represent products not available for the current flu season.

Lastly, don’t forget the immunization administration code.

Read the related FPM “Coding and Documentation” Q&A: “Flu Vaccine Coding.”

Posted on Aug 29, 2019 by FPM Editors