Medicare Compliance & Reimbursement

Question: Do flu vaccines always require two codes?

Answer: Yes, according to Humana. “In order to help ensure correct billing and payment, two codes are needed for each vaccination claim: one administrative code and one vaccine code,” the payer says. You’ll report a flu vaccine administration code (such as 90460-90474) and another code for the vaccine itself, such as 90630 (Influenza virus vaccine, quadrivalent [IIV4], split virus, preservative free, for intradermal use), 90653 (Influenza vaccine, inactivated [IIV], subunit, adjuvanted, for intramuscular use), or another appropriate code that describes the material injected.

Therefore, if you administer a flu shot that includes preservatives to a nine-year-old child and the family physician performs counseling, you’ll likely report 90460 (Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; first or only component of each vaccine or toxoid administered) and 90658 (Influenza virus vaccine, trivalent [IIV3], split virus, when administered to individuals 3 years of age and older, for intramuscular use). Use Z23 (Encounter for immunization) as the diagnosis code.

Coding Tip: Although the example refers to a flu shot, this rule is generally true of all vaccines — you should bill an administration code as appropriate and a code for the actual vaccine.

“Note that, for Medicare, the codes may not be CPT^® codes,” points out Kent Moore, senior strategist for physician payment at the American Academy of Family Physicians. “For instance, administration of Afluria to a Medicare patient will likely require you to report G0008 (Administration of influenza virus vaccine) and Q2035 (Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use Afluria,” Moore adds.