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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.

Medical Coding for the 2012-2013 FLU Season (Influenza Virus Vaccine)


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-and-Education/Medicare-Learning-Network and access MLN Matters Number: MM8047 Revised.

 

 

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READ THIS LATER! DOWNLOAD THE PDF >> CLICK HERE <<
2016-11-20T23:38:43+00:00

About the Author:

JoAnne Sheehan
JoAnne Sheehan has been successfully providing medical billing, coding and practice management services in the New England area for over thirty-three years. She has witnessed the evolution of healthcare and the increased complexities of medical billing and coding regulations, creating a need for education in this field. JoAnne has been featured in numerous medical publications and has acted as a medical billing expert in highly profiled Medicare and Medicaid fraud cases in Boston and has trained others on both a local and national level in medical billing and coding. She is a certified medical coding instructor, practice management consultant, and an AAPC approved ICD-10-CM instructor. Her hands-on experience is an asset for the CCO students she coaches. She is President and Founder of Lomar Associates, Inc., a practice management company established in 1981.

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