2010-11 Influenza Season

Academy Answers Member Inquiries on Flu Vaccine Coding, Billing

October 13, 2010 04:55 pm Sheri Porter

Influenza season has arrived, and that means family physicians are ramping up their vaccination efforts as the AAFP fields member questions about influenza vaccine protocols for the 2010-2011 flu season.

Cindy Hughes, C.P.C., an AAFP coding specialist, has answered several calls from family physicians in recent days. Based on the nature of those calls, she offered these timely reminders to AAFP members about flu vaccinations.

  • There is no separate and specific code for the novel influenza A (H1N1) vaccine this year because the 2010-2011 seasonal influenza vaccine includes the H1N1 strain.
  • Physicians should report two codes to bill for influenza vaccination services: the appropriate CPT code for the flu vaccine given and the appropriate CPT code for vaccine administration. A complete list of CPT codes pertinent to the 2010-2011 influenza season is included in Family Practice Management's "Getting Paid" blog entry Organize to Immunize - Flu Season Is Coming, which posted on Aug. 26.
  • This is the first year that the CDC's Advisory Committee on Immunization Practices has recommended that influenza vaccinations be given to all people ages 6 months and older in whom the vaccine is not contraindicated.
  • Physicians should use CPT code 90662 when billing for Fluzone High-Dose, a new flu vaccine approved in December 2009(www.fda.gov) for use in people ages 65 and older.
  • Seasonal flu vaccination is an annual benefit for Medicare beneficiaries; however, a beneficiary could conceivably receive a seasonal influenza vaccination twice in one calendar year for two different flu seasons. In that situation, physicians can bill -- and will be paid -- for both vaccine services.

Additional resources that Medicare physicians might find handy during the 2010-2011 influenza season are available from CMS via a recent issue of the agency's online provider publication, MLN Matters(www.cms.gov). CMS urges physicians and other Medicare fee-for-service providers to keep the issue for reference throughout the current flu season.

The MLN Matters issue contains a plethora of Web links leading to current influenza articles, resources and other information. CMS also reminds physicians about some common-sense influenza strategies, such as

  • use each office visit as an opportunity to encourage patients to get a flu shot;
  • provide the seasonal flu shot as long as vaccine is available, even after the new year; and
  • ensure that every physician and staff person in the office gets a flu shot.

According to CMS, each year, about 36,000 people die from flu-related causes.