Forum - Questions & Answers

Aug 5th, 2011 - Lova123 10 

Medicare Flu Shots

Does anyone know the 2011-2012 Medicare reimbursement for the flu shot? Also is there a new CPT® code for it? New admin code?

Sep 9th, 2011 - manskemd 2 

re: Medicare Flu Shots

http://www.capturebilling.com/2011-medicare-codes-for-flu-shots-q2035-q2036-q2037-q2038/

Below copied from above link

2011 Medicare Codes for Flu Shots: Q2035, Q2036, Q2037, Q2038
Posted by Manny Oliverez - Medical Billing Company CEO 7 Comments
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Medicare Flu Shots
New Medicare Influenza Vaccine Q Codes for 2011

Effective January 1, 2011 the Centers for Medicare & Medicaid Services (CMS) will no longer recognize and no longer reimburse CPT® Code 90658 Influenza Virus Vaccine, Split Virus for flu shots. CMS has established five separate influenza vaccine HCPCS codes to distinguish between the brand-names of influenza vaccines for governmental tracking purposes. Make sure to use these new codes in your medical billing.
New Medicare codes distinguish between vaccine brands for Medicare
The HCPCS code G0008 Administration of Influenza Virus Vaccine must still be used for the administration of the flu vaccine for Medicare patients.

The New HCPCS Medicare Flu Vaccine Codes
Q2035 Afluria Vaccine:

Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Afluria)
Q2036 Flulaval Vaccine:

Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Flulaval)
Q2037 Fluvirin Vaccine:

Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Fluvirin)
Q2038 Fluzone Vaccine:

Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Fluzone)
Q2039 NOS (Not Otherwise Specified) Vaccine:

Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Not Otherwise Specified)
Reimbursement Rates

The national average for Medicare payment allowance may vary by geographical location and you will need to check the CMS Fee Schedule for your correct reimbursement rate. HCPCS codes Q2035 & Q2039 do not have national payment limits and will be determined by the local Medicare carrier.

National allowables for the Q2036 is $7.439, Q2037 is $13.253, and Q2038 is $12.593.

Please refer to the CMS Physician Fee Schedule at: http://www.cms.gov/PhysicianFeeSched/01_overview.asp

Additional information can also be found at: http://www.cms.gov/MLNMattersArticles/downloads/MM7234.pdf

For a video on Medicare flu shot coding go to: What are the Medicare Flu Shot Codes
Take a Look at these Related Posts:

Medicare: Video Helps Explain New Influenza Vaccine Q Codes for 2011
Medical Billing Tips: Coding for Medicare Flu Shots
Coding for the 2010 Flu Shot: Three Vaccines, One Code

Sep 15th, 2011 - hfk 1 

re: Medicare Flu Shots

for 2011-2012 year -

is Q2039 still the code for Fluzone for medicare? What about administration code? Is it g0008?

Have there been any changes for the 90658/90471 for all other insurances?



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