Flu and Pneumonia Vaccine Coding and Allowance
The Medicare Modernization Act of 2003 (MMA), Section 303, revises the payment methodology for Part B covered drugs and biologicals that are not paid on a cost or prospective payment basis. For influenza and pneumococcal vaccines, payment allowance limits are 95 percent of the AWP as reflected in the published compendia. The payment allowance limits are updated on a quarterly basis.
There are five (5) CPT procedure codes for the flu vaccine. Effective with dates of service October 1, 2007 and after, when billing for the influenza virus vaccine, providers can use:
90655 Influenza virus vaccine, split virus, preservative free, for children 6-35 months of age, for intramuscular use
90656 Influenza virus vaccine, split virus, preservative free, for use in individuals 3 years and above, for intramuscular use
90657 Influenza virus vaccine, split virus, for children 6-35 months of age, for intramuscular use
90658 Influenza virus vaccine, split virus, for use in individuals 3 years of age and above, for intramuscular use
90660 90660 Influenza virus vaccine, live, for intranasal use
For the Pneumococcal vaccine, providers can use:
90732 Pneumococcal polysaccharide vaccine, 23-valent, adult or immunosuppressed patient dosage for use in individuals 2 years or older, for subcutaneous or intramuscular use
Flu and Pneumococcal Vaccine Allowance
- Annual Part B deductible and coinsurance amounts do not apply.
- All physicians, non-physician, suppliers and practitioners who administer the influenza virus vaccination must take assignment on the claim for the vaccine.
- The service is not subject to a payment reduction for non-participating providers.
The following Medicare approved charges are in effect for the influenza virus and pneumococcal vaccines with dates of service October 1, 2007 and after.
Influenza vaccine payments are:
CPT 90655 is $16.109;
CPT 90656 is $17.366;
CPT 90657 is $6.609;
CPT 90658 is $13.218; and
CPT 90660 (FluMist, a nasal influenza vaccine) is $21.176 and providers should note that CPT 90660 may be covered in those cases where the local Medicare contractor determines that its use is medically reasonable and necessary for the beneficiary.
Pneumococcal vaccine payments are:
CPT 90732 is $32.70; and
CPT 90669 is $78.803.
Administration Fees:
http://www.cms.hhs.gov/AdultImmunizations/
Downloads/ImmunAdminRates07.pdf 
Page Last Updated: Monday, 09-Jun-2008 13:34:15 CDT
