Internal Medicine Coding Alert

Published on Sun Jan 16, 2011 PDF

Pay for 3 of your most common vaccine codes will rise.

Your internal medicine physician should be smiling about the vaccine reimbursement amounts for 2012 -- CMS gave practices a break with updates to its seasonal influenza vaccine pricing.

CMS payment changes related to flu vaccines are as follows:

• 90654 (Influenza virus vaccine, split virus, preservative free, for intradermal use) -- $18.383
• 90655 (Influenza virus vaccine, split virus, preservative free, when administered to children 6-35 months of age, for intramuscular use) -- $15.705, which is an increase from $14.858 last year
• 90656 (Influenza virus vaccine, split virus, preservative free, when administered to individuals 3 years and older, for intramuscular use) -- $12.375, which is the same as last year
• 90657 (Influenza virus vaccine, split virus, when administered to children 6-35 months of age, for intramuscular use) - $6.653, a slight increase from $6.297 last year
• 90660 (Influenza virus vaccine, live, for intranasal use) - $22.316, the same as last year
• 90662 (Influenza virus vaccine, split virus, preservative free, enhanced immunogenicity via increased antigen content, for intramuscular use) - $30.923, up from $29.213 last year.

The AMA introduced 90654 effective Jan. 1, 2011, but it was too late to be included in the 2011 CPT® manual, says Jill M. Young, CPC, CEDC, CIMC, with Young Medical Consulting, LLC, in East Lansing, Mich. It became payable by Medicare on May 9, 2011, which explains why it doesn't have a comparison fee schedule amount like the other vaccine codes.

Time frame: The current Medicare influenza vaccine payment allowances are effective for dates of service between Sept. 1, 2011, and Aug. 31, 2012.

Other fees apply for flu vaccines administered on earlier dates. For more on CMS's flu pricing, visit www.cms.gov/McrPartBDrugAvgSalesPrice/10_VaccinesPricing.asp.