Medicare Compliance & Reimbursement

“This recommendation change will be welcome relief for clinicians required to carefully maintain separate vaccine supplies for allergic patients,” says Jan Blanchard, CPC, CPEDC, CPMA, pediatric solutions consultant at Physician’s Computer Company in Winooski, Vermont. “The labor and storage expenses for vaccine inventory tracking and reconciliation are poorly paid as it is. Every little bit of time saved in this crucial preventive care is a gain,” she continues.

Know Which Vax Codes to Report for 65+

The following are the product codes for patients 65 years and older:

• Fluzone High-Dose Quadrivalent 0.7 mL pre-filled syringe, reported using 90662 (Influenza virus vaccine (IIV), split virus, preservative free, enhanced immunogenicity via increased antigen content, for intramuscular use)
• Fluad Quadrivalent 0.5 mL pre-filled syringe, reported using 90694 (Influenza virus vaccine, quadrivalent (aIIV4), inactivated, adjuvanted, preservative free, 0.5 mL dosage, for intramuscular use)

Realize Absence of 0.25 mL Pre-Filled Fluzone

Fluzone Quadrivalent (approved for children aged 6-35 mo. at either 0.25 mL or 0.5 mL per dose) is no longer available in 0.25 mL prefilled syringes. Therefore, you’ll need to code 90686 (Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, 0.5 mL dosage, for intramuscular use) if the child in this age group receives the higher dose from the pre-filled syringe. This code also includes quadrivalent Afluria, Fluarix, and FluLaval.

Check Out This COVID Guidance

The ACIP says that “inactivated and recombinant influenza vaccines may be administered concurrently or sequentially with other live or inactivated vaccines.” In other words, the clinician can administer the live attenuated flu vaccine simultaneously with other inactivated or live vaccines. However, “if two live vaccines are not given simultaneously, then administration of a live attenuated influenza vaccine and another live vaccine should occur at least four weeks apart,” ACIP advises.

The ACIP also recommends that clinicians defer influenza vaccination for those patients who are moderately or severely ill until they recover. They say that clinicians can use their judgment whether to defer flu vaccination for people with mild COVID-19 symptoms or who are asymptomatic.

Note: Effective Nov. 1, 2023, CPT^® simplified COVID vaccine coding by consolidating the 50+ immunization codes (see Medicare Compliance & Reimbursement, Vol. 49, No. 22). When reporting both vaccines for the same encounter, be sure to report the COVID vaccines from the updated code set. Also, the administration code for COVID-19 products differs from what you’ll report for flu vaccines. For ongoing guidance, check this AMA site regularly: www.ama-assn.org/practice-management/cpt/covid-19-cpt-coding-and-guidance.

Remember Administration Codes

For the flu vaccinations, make sure you add an immunization administration code from 90460 (Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional…), 90471 (Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections) …), or 90473 (Immunization administration by intranasal or oral route …) as appropriate, unless the patient is a Medicare beneficiary. For Medicare patients, you should report the administration with G0008 (Administration of influenza virus vaccine).