by Find-A-Code™
Jan 4th, 2018
Per CMS: Medicare provides coverage of the flu vaccine without any out-of-pocket costs to the Medicare patient. No deductible or copayment/coinsurance applies. Annual Part B deductible and coinsurance amounts do not apply.
Payment allowance limits for personal flu and pneumococcal vaccines are 95 percent of the Average Wholesale Price (AWP), except where the vaccine is furnished in a hospital outpatient department, Rural Health Clinic (RHC), or Federally Qualified Health Center (FQHC). In these cases, the payment for the vaccine is based on reasonable cost.
CPT 90630 $20.343 8/1/2017-7/31/2018
CPT 90653 $50.217 8/1/2017-7/31/2018
CPT 90654 Pending 8/1/2017-7/31/2018
CPT 90655 Pending 8/1/2017-7/31/2018
CPT 90656 $19.247 8/1/2017-7/31/2018
CPT 90657 Pending 8/1/2017-7/31/2018
CPT 90661 Pending 8/1/2017-7/31/2018
CPT 90662 $49.025 8/1/2017-7/31/2018
CPT 90672 Pending 8/1/2017-7/31/2018
CPT 90673 $40.613 8/1/2017-7/31/2018
CPT 90674 $24.047 8/1/2017-7/31/2018
CPT 90682 $46.313 8/1/2017-7/31/2018 (New code)
CPT 90685 $21.198 8/1/2017-7/31/2018
CPT 90686 $19.032 8/1/2017-7/31/2018
CPT 90687 $9.403 8/1/2017-7/31/2018
CPT 90688 $17.835 8/1/2017-7/31/2018
CPT 90756* $22.793 1/1/2018-7/31/2018
HCPCS Q2039** ** See Note below ** 8/1/2017-7/31/2018
HCPCS Q2035 $17.685 8/1/2017-7/31/2018
HCPCS Q2036 Pending 8/1/2017-7/31/2018 HCPCS Q2037 $17.685 8/1/2017-7/31/2018
HCPCS Q2038 Pending 8/1/2017-7/31/2018
*Until CPT code 90756 is implemented on 1/1/2018, Q2039 will be used for products described by the following language: influenza virus vaccine, quadrivalent (ccllV4), derived from cell cultures, subunit, antibiotic free, 0.5mL dosage, for intramuscular use. The payment allowance for these products, effective for dates of service from 8/1/2017 to 12/31/2017, is $22.793. **Providers and MACs will use HCPCS Q2039 for dates of service from 8/1/2017- 12/31/2017. HCPCS Q2039 Flu Vaccine Adult – Not Otherwise Classified.
The payment allowance will be determined by the local claims processing contractor with effective dates of 8/1/2017-7/31/2018. Providers are encouraged to review MLN Matters Article MM10224. If you have any questions, please contact your MAC at their toll-free number. That number is available at https://www.cms.gov/Research-Statistics-Data-and-Systems/MonitoringPrograms/Medicare-FFS-Compliance-Programs/Review-Contractor-Directory-Interactive-Map/.
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