Is anyone else having trouble getting paid for this year's Flu Vaccine? We have the Afluria Trivalent vaccine, and according to CMS, we should be using 90658. I am getting denials from Medicare, and Medicare Advantage plans, saying FCSO says it is an invalid code.
UPDATE 09/19/24 - CMS MLN Connects today includes:
Influenza Vaccine: Holding Claims for CPT Code 90658
CMS is aware of an issue affecting payment for CPT code 90658:
- Long descriptor: Influenza virus vaccine, trivalent (IIV3), split virus, 0.5 mL dosage, for intramuscular use
- Short descriptor: IIV3 VACCINE SPLT 0.5 ML IM
We’re holding claims for CPT code 90658 for dates of service on or after August 1, 2024, until October 7, 2024.
_________________________________
Your Medicare Administrative Contractor will reprocess any denied claims by November 1, 2024. You don’t need to take any action.
So, this may not be the issue, but increasingly the effective and implementation dates in Medicare transmittals are not supportive of prompt payment. The implementation date for Change Request 13718, Influenza Vaccine Payment Allowances - Annual Update for 2024-2025 Season, is "September 30, 2024 - No later than." One of the instructions in the change request is, "The contractors shall use the Cloud vaccine pricing data to determine the payment limit for claims for payable Medicare Part B vaccines processed or reprocessed on or after August 1, 2024, with dates of service August 1, 2024, through July 31, 2025." Note the "reprocessed" in this instruction that implies allowance for late updates to the fee schedules and claims processing systems. Chances are the MACs will perform automatic reprocessing after the systems are updated and, hopefully, the same would apply to the MA plans.
Your Seqirus rep may have an idea of whether or not this is the issue and whether the same thing is occurring with commercial payers.
Cindy