# CPT 90688-  Fluvalal.  Mcare denials?



## beck123 (Dec 9, 2013)

My practice ran out of flu vaccine, and the only available vaccine in our area was the Fluvalal, quadrivalent w/ preservatives vaccine.  We ordered 100 doses and began billing for it.  I checked w/ GSK and the correct CPT code for this is 90688 since it is WITH preservatives as opposed to without, which is 90686.  

Unfortunately, Medicare is denying it for medical necessity.  They list a payment for it on their website, but apparently this doesn't mean they will pay it.  The code did have a lightning bolt for FDA approval pending in the book, but it was approved in August of this year.

So we are now having to appeal and prove medical necessity for all the Medicare doses we gave out.  

Has anyone else had to deal with this issue?  Any helpful tips?

Thanks!


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## kellyobenour@yahoo.com (Dec 18, 2013)

If I am not mistaken you must use Medicare codes to be reimbursed.  

Q2036 Flu Virus Vaccine, split virus, when admin to 3 years and older, IM (flulaval)

Admin Code G0008
Dx: V04.81

Someone else might want to chime in and verify?


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## Pam Brooks (Dec 19, 2013)

Kelly, you're absolutely right~


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## beck123 (Dec 23, 2013)

That is the code for Fluvalal, for Medicare, but this is Quadrivalent, not trivalent, so my understanding was it would be a different code.  It is listed on Medicare's fee schedule as 90688, but our MAC won't pay it apparently.  I don't think it would be right to bill Q2036 since I think that is the code for the trivalent...Thanks for you help!  I'll continue to look into this.  For now we are appealing.


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## bvanlaan@hotmail.com (Jan 29, 2014)

Hi Beck,

I disagree with the others on this one.  Even though it is Medicare you are filing with it is a Quadrivalent flu vaccine not a trivalent which is what the current Q codes cover.  I believe you would use the CPT code 90688 just as if you were filing a High Dose flu 90662 that is recommended for all adults 65+ which also does not have a Q code.  I am having the same issue with some commercial plans that simply do not recognize the newest code 90688 and am having to send hundreds back for review or appeal.


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## Herbie Lorona (Jan 30, 2014)

This is the newest thing I have seen and it is from September 2013. It says it is still pending.

https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R2786CP.pdf


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