Medicare coverage on Seasonal Flu Vaccinations
Generally, Medicare Part B covers one flu vaccination and its administration per flu season for beneficiaries without co-pay or deductible. Now is the perfect time to vaccinate beneficiaries.
Health care providers are encouraged to get a flu vaccine to help protect themselves from the flu and to keep from spreading it to their family, co-workers, and patients.
Note: The flu vaccine is not a Part D-covered drug.
This recurring update notification provides the payment allowances for the following seasonal influenza virus vaccines, when payment is based on 95 percent of the Average Wholesale Price (AWP).
CPT 90655 Payment allowance is pending. Effective dates: 8/1/2014 – 7/31/2015
CPT 90656 Payment allowance is pending. Effective dates: 8/1/2014 – 7/31/2015
CPT 90657 Payment allowance is pending. Effective dates: 8/1/2014 – 7/31/2015
CPT 90661 Payment allowance is pending. Effective dates: 8/1/2014 – 7/31/2015
CPT 90685 Payment allowance is pending. Effective dates: 8/1/2014 – 7/31/2015
CPT 90686 Payment allowance is pending. Effective dates: 8/1/2014 – 7/31/2015
CPT 90687 Payment allowance is pending. Effective dates: 8/1/2014 – 7/31/2015
CPT 90688 Payment allowance is pending. Effective dates: 8/1/2014 – 7/31/2015
HCPCS Q2035 Payment allowance is pending. Effective dates: 8/1/2014 – 7/31/2015
HCPCS Q2036 Payment allowance is pending. Effective dates: 8/1/2014 – 7/31/2015
HCPCS Q2037 Payment allowance is pending. Effective dates: 8/1/2014 – 7/31/2015
HCPCS Q2038 Payment allowance is pending. Effective dates: 8/1/2014 – 7/31/2015
Payment for the following CPT or HCPCS codes may be made if your MAC determines its
use is reasonable and necessary for the beneficiary, during the effective dates indicated
below:
CPT 90654 Payment allowance is pending. Effective dates: 8/1/2014 – 7/31/2015
CPT 90662 Payment allowance is pending. Effective dates: 8/1/2014 – 7/31/2015
CPT 90672 Payment allowance is pending. Effective dates: 8/1/2014 – 7/31/2015
CPT 90673 Payment allowance is pending. Effective dates: 8/1/2014 – 7/31/2015
HCPCS Q2039 Flu Vaccine Adult – Not Otherwise Classified payment allowance is to be
determined by the local claims processing contractor with effective dates of 8/1/2014 –
7/31/2015.
Payment allowances for codes for products that have not yet been approved will be provided
when the products have been approved and pricing information becomes available to CMS.
The payment allowances for pneumococcal vaccines are based on 95 percent of the AWP
and are updated on a quarterly basis via the Quarterly Average Sales Price (ASP) Drug
Pricing Files. The Medicare Part B payment allowance limits for influenza and pneumococcal vaccines are 95 percent of the AWP as reflected in the published compendia except where the vaccine is furnished in a hospital outpatient department, Rural Health Clinic (RHC), or Federally
Qualified Health Center (FQHC). Where the vaccine is furnished in the hospital outpatient
department, RHC, or FQHC, payment for the vaccine is based on reasonable cost.
Annual Part B deductible and coinsurance amounts do not apply. All physicians, non-physician practitioners, and suppliers who administer the influenza virus vaccination and the pneumococcal vaccination must take assignment on the claim for the vaccine.
Note: MACs will not search their files either to retract payment for claims already paid or to retroactively pay claims prior to the implementation date of CR8890. However, they will adjust claims that you bring to their attention.
Generally, Medicare Part B covers one flu vaccination and its administration per flu season for beneficiaries without co-pay or deductible. Now is the perfect time to vaccinate beneficiaries.
Health care providers are encouraged to get a flu vaccine to help protect themselves from the flu and to keep from spreading it to their family, co-workers, and patients.
Note: The flu vaccine is not a Part D-covered drug.
This recurring update notification provides the payment allowances for the following seasonal influenza virus vaccines, when payment is based on 95 percent of the Average Wholesale Price (AWP).
CPT 90655 Payment allowance is pending. Effective dates: 8/1/2014 – 7/31/2015
CPT 90656 Payment allowance is pending. Effective dates: 8/1/2014 – 7/31/2015
CPT 90657 Payment allowance is pending. Effective dates: 8/1/2014 – 7/31/2015
CPT 90661 Payment allowance is pending. Effective dates: 8/1/2014 – 7/31/2015
CPT 90685 Payment allowance is pending. Effective dates: 8/1/2014 – 7/31/2015
CPT 90686 Payment allowance is pending. Effective dates: 8/1/2014 – 7/31/2015
CPT 90687 Payment allowance is pending. Effective dates: 8/1/2014 – 7/31/2015
CPT 90688 Payment allowance is pending. Effective dates: 8/1/2014 – 7/31/2015
HCPCS Q2035 Payment allowance is pending. Effective dates: 8/1/2014 – 7/31/2015
HCPCS Q2036 Payment allowance is pending. Effective dates: 8/1/2014 – 7/31/2015
HCPCS Q2037 Payment allowance is pending. Effective dates: 8/1/2014 – 7/31/2015
HCPCS Q2038 Payment allowance is pending. Effective dates: 8/1/2014 – 7/31/2015
Payment for the following CPT or HCPCS codes may be made if your MAC determines its
use is reasonable and necessary for the beneficiary, during the effective dates indicated
below:
CPT 90654 Payment allowance is pending. Effective dates: 8/1/2014 – 7/31/2015
CPT 90662 Payment allowance is pending. Effective dates: 8/1/2014 – 7/31/2015
CPT 90672 Payment allowance is pending. Effective dates: 8/1/2014 – 7/31/2015
CPT 90673 Payment allowance is pending. Effective dates: 8/1/2014 – 7/31/2015
HCPCS Q2039 Flu Vaccine Adult – Not Otherwise Classified payment allowance is to be
determined by the local claims processing contractor with effective dates of 8/1/2014 –
7/31/2015.
Payment allowances for codes for products that have not yet been approved will be provided
when the products have been approved and pricing information becomes available to CMS.
The payment allowances for pneumococcal vaccines are based on 95 percent of the AWP
and are updated on a quarterly basis via the Quarterly Average Sales Price (ASP) Drug
Pricing Files. The Medicare Part B payment allowance limits for influenza and pneumococcal vaccines are 95 percent of the AWP as reflected in the published compendia except where the vaccine is furnished in a hospital outpatient department, Rural Health Clinic (RHC), or Federally
Qualified Health Center (FQHC). Where the vaccine is furnished in the hospital outpatient
department, RHC, or FQHC, payment for the vaccine is based on reasonable cost.
Annual Part B deductible and coinsurance amounts do not apply. All physicians, non-physician practitioners, and suppliers who administer the influenza virus vaccination and the pneumococcal vaccination must take assignment on the claim for the vaccine.
Note: MACs will not search their files either to retract payment for claims already paid or to retroactively pay claims prior to the implementation date of CR8890. However, they will adjust claims that you bring to their attention.