Flu vaccine code changes coming in 2014

Prepare now for a handful of changes coming to the way you code for influenza vaccinations in 2014. Getting paid successfully, however, may require you to hold onto some claims for longer than you would ordinarily like.

CMS has directed the Medicare Administrative Contractors (MACs) to pay for flu vaccine code 90673 beginning with dates of service of Jan. 1, 2014 or later. Here’s the catch. When the claim is processed prior to April 7, 2014, payment is to be based on “local pricing guidelines,” according to the transmittal.

The agency has not yet set a payment limit amount for this code, though that is expected in early 2014. When your claim is processed on or after April 7, 2014, payment will be based on that national payment amount.

As is usually the case with influenza vaccine codes coinsurance and deductible do not apply to these services.

These codes are being removed from the Medicare Claims Processing Manual for influenza vaccination, with the effective date backdated to July 1, 2013: 90658, Q2034, Q2035, Q2036, Q2037, Q2038 and Q2039. CMS has not confirmed that it will no longer pay for these codes, though it’s advisable for you to avoid using them whenever possible.