There are specific guidelines to follow when submitting claims for the influenza virus vaccine for 2012-2013.
Coders must know whether or not the claim is a Medicare or non-Medicare submission. They must also know the brand of the vaccine, whether it is preservative free, a pediatric dose or a high dose and if it is administered as an intradermal or nasal vaccine.
When billing for Medicare patients, coders will use special HCPCS codes beginning with the letter Q while non-Medicare patients will utilize CPT® codes.
For this flu season, Medicare has introduced a new code, Q2034, with the brand name Agriflu. The effective date for this new code is for claims with dates of service on or after July 1, 2012 and processed on or after October 1, 2012. Medicare contractors will reimburse Q2034 based on local pricing guidelines or 95% of the average wholesale price.
Physicians using Fluarix (preservative free) a single-dose syringe for ages 3 years and older, for Medicare patients should not use the NOS HCPCS code Q2039. The proper code would be 90656.
Administration of the Flu Vaccine Code is G0008 for Medicare claims and 90471 for non-Medicare. The diagnosis code should be V04.81
The following Influenza virus vaccine codes are strictly for Medicare patients and are for intramuscular use:
- Q2034 Agriflu Influenza virus vaccine, split virus, 3 years or older
- Q2035 Afluria Influenza virus vaccine, split virus, 3 years or older
- Q2036 Flulaval Influenza virus vaccine, split virus, 3 years or older
- Q2037 Fluvirun Influenza virus vaccine, split virus, 3 years or older
- Q2038 Fluzone Influenza virus vaccine, split virus, 3 years or older
- Q2039 NOS Influenza virus vaccine, split virus, 3 years or older
- 90656 Fluarix Influenza virus vaccine, preservative free
To download a comprehensive grid of the influenza vaccine products with Medicare and non-Medicare CPT® and HCPCS codes for this current season, visit www.immunize.org.
For specific Medicare guidelines on the influenza vaccine, log on to http://www.cms.gov/Outreach-
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