New Codes, Fees Announced for Flu Vaccines

The Centers for Medicare and Medicaid Services (CMS) has created specific HCPCS codes and payment allowances for each name-brand influenza vaccine provided to Medicare beneficiaries.

As a result, Medicare will no longer pay claims for CPT code 90658 (flu vaccine, 3 years and older) for service dates on or after Jan. 1, 2011.

Highmark Medicare Services (HMS) has also announced fees for flu vaccinations for 2011. You can find those fees on the HMS website.

The new HCPCS codes are:

Code Vaccine Brand
Q2035 Afluira
Q2036 Flulaval
Q2037 Fluvirin
Q2038 Fluzone
Q2039 Not otherwise specified

For more details see the MLN Matters newsletter on vaccine codes.

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Comments: 1


According to projected reimbursement our practice will lose money on flu vacinations. We are small and only order 1000 doses so cannot get volume discounts like the chain grocery stores can and thus get their costs covered. 95% of the average price means this will occur for a substantial number of purchasers from practices like ours. Therefore we will not be able to provide the service. Goal seems to be to drive our practices out of business. Are the stores going to provide the primary care that goes along with services like flu shots? What is PMS doing about the huge inroads this year on our ability to survive in small practices? We are being considered dinosaurs and will become extinct.

Ron Krablin, MD at 2/4/2011 10:04:13 AM

Last Updated: 1/5/2011
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