With the recent switch from summer to fall, the 2017 flu season is officially upon us. While those with proper foresight (or perhaps just extreme fear of the debilitating disease) have already swung by their local doctors’ offices or pharmacies to receive the latest vaccination, millions more will flock in over the coming months as the weather continues to cool. With so many vaccines being distributed, there has never been a better time for coders to brush up on their corresponding codes.
For the 2017 flu season, two new CPT vaccine codes have entered the mix. Code 90682 (Influenza virus vaccine, quadrivalent (RIV4), derived from recombinant DNA, hemagglutinin (HA) protein only, preservative and antibiotic free, for intramuscular use) will be in effect from August 1st of this year until July 31st of 2018. On the other hand, code 90756 (Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, antibiotic free, 0.5mL dosage, for intramuscular use) will not go into effect until January 1st, though it will also last through the end of July. Until the beginning of next year when the codes officially takes effect, CMS recommends instead reporting HCPCS Level II code Q2039 (Influenza virus vaccine, not otherwise specified). Regardless of which one you report, be sure to include HCPCS Level II code G0008 (Administration of influenza virus vaccine) or something similar to account for the administration of the vaccine itself.
Unless the vaccine is given in a hospital outpatient setting (at which point it is charged under a “reasonable cost”), the payment allowance for a standard flu vaccination is 95% of the average wholesale price. As a general rule, receiving an annual flu shot is a covered benefit for most major insurance providers, meaning that there is no copayment or coinsurance, nor a need for the person to have already met his or her deductible.