Internal Medicine Coding Alert

Reader Question:

Try FluMist Code With Private Payers

Question: How should we report the new FluMist vaccine? Do payers place restrictions on its use?

Idaho Subscriber

Answer: For some private insurers, you may bill for the new intranasal flu vaccine using a nonintramuscular immunization code, but Medicare probably won't reimburse you.
 
The reason is the Food and Drug Administration recently licensed the intranasal flu vaccine FluMist for healthy patients between the ages of 5 and 49, which excludes most Medicare patients and those with diseases such as cancer or AIDS.
 
Also, most payers consider the vaccine experimental. If your internist plans to offer FluMist, you should report the services using the following codes:

 

  •  administration - 90473, Immunization administration by intranasal or oral route; one vaccine (single or combination vaccine/toxoid)
     
  •  product - 90660, Influenza virus vaccine, live, for intranasal use.

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