New Medicare Flu Vaccine Codes for 2011

Medicare Influenza Vaccine2011 Medicare Codes for Flu Shots: Q2035, Q2036, Q2037, Q2038

Effective January 1, 2011 the Centers for Medicare & Medicaid Services (CMS) will no longer recognize and no longer reimburse CPT Code 90658 Influenza Virus Vaccine, Split Virus for flu shots.  CMS has established five separate influenza vaccine HCPCS codes to distinguish between the brand-names of influenza vaccines for governmental tracking purposes.

The HCPCS code G0008 Administration of Influenza Virus Vaccine must still be used for the administration of the flu vaccine for Medicare patients.

The New HCPCS Flu Vaccine Codes

Q2035 Afluria Vaccine:

Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Afluria)

Q2036 Flulaval Vaccine:

Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Flulaval)

Q2037 Fluvirin Vaccine:

Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Fluvirin)

Q2038 Fluzone Vaccine:

Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Fluzone)

Q2039 NOS (Not Otherwise Specified) Vaccine:

Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Not Otherwise Specified)

Reimbursement Rates

The national average for Medicare payment allowance may vary by geographical location and you will need to check the CMS Fee Schedule for your correct reimbursement rate.

HCPCS codes Q2035 & Q2039 do not have national payment limits and will be determined by the local Medicare carrier.

National allowables for the Q2036 is $7.439, Q2037 is $13.253, and Q2038 is $12.593.

Please refer to the CMS Physician Fee Schedule at: http://www.cms.gov/PhysicianFeeSched/01_overview.asp
Additional information can also be found at: http://www.cms.gov/MLNMattersArticles/downloads/MM7234.pdf
For a video on Medicare flu shot coding go to:
What are the Medicare Flu Shot Codes

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