Medicare Part B has set the cost of seasonal flu vaccinations for the 2023–2024 influenza season at 95 percent of their Average Wholesale Price (AWP). Outpatient hospitals will calculate reimbursement based on fair pricing for procedures performed using these vaccines. Note that when administering flu vaccines, standard coinsurance and deductible fees do not apply; every healthcare provider and supplier must accept claims related to flu shots assigned under Medicare Part B.
The flu vaccination season runs annually between August 1 and July 31. This timeline ensures that people receive their shots well ahead of the flu’s peak season and provides more protection from its virus.
Why Everyone Should Consider Getting a Flu Shot Annually.
The Centers for Disease Control and Prevention (CDC) advises adults over 6 months old to receive an influenza vaccination annually to stay protected against influenza outbreaks during flu season. For maximum effectiveness of protection during this season, vaccination should take place between September and October for maximum efficiency of protection.
Coverage Under Medicare Part B
For those who qualify, Medicare Part B pays the flu vaccination costs, so if their healthcare provider approves, they won’t have to pay any copayments, coinsurance, or deductibles.
Provision for Additional Flu Shots
In these cases, Medicare covers patients by covering both flu vaccinations for each season they need throughout the year. Multiple flu shots are medically necessary throughout a calendar year, such as when two distinct flu seasons overlap. Medicare supports them by covering these additional shots at no cost to ensure continuous protection throughout.
How to Check Patient Eligibility for the Flu Shot
Healthcare professionals seeking to determine whether patients qualify to get flu shots may include:
- A comprehensive list of applicable CPTs or HCPCS codes.
- The specific dates of service.
- Information on the National Provider Identifiers (NPIs) who administered the shots.
Providers offering services over the past 18 months can utilize this data to check patient eligibility and download PDF documents of patient documents.
Flu Shot & Administration (HCPCS & CPT Codes):
| CPT Code |
Description |
| G0008 | Administration of influenza virus vaccine |
| 90662 | Influenza virus vaccine (IIV), split virus, preservative free, enhanced immunogenicity via increased antigen content, for intramuscular use |
| 90672 | Influenza virus vaccine, quadrivalent, live (LAIV4), for intranasal use |
| 90674 | Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage, for intramuscular use |
| 90682 | Influenza virus vaccine, quadrivalent (RIV4), derived from recombinant DNA, hemagglutinin (HA) protein only, preservative and antibiotic free, for intramuscular use |
| 90686 | Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, 0.5 mL dosage, for intramuscular use |
| 90687 | Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.25 mL dosage, for intramuscular use |
| 90688 | Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.5 mL dosage, for intramuscular use |
| 90694 | Influenza virus vaccine, quadrivalent (aIIV4), inactivated, adjuvanted, preservative-free, 0.5 mL dosage, for intramuscular use |
| 90756 | Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, antibiotic free, 0.5 mL dosage, for intramuscular use |
| Q2039 | Influenza virus vaccine, not otherwise specified |
Here are the payment allowances and effective dates for the Seasonal Flu Vaccines of 2023-2024
| CPT Code | Labeler Name | Vaccine Name | Payment Allowance | Effective Dates |
| 90662 | Sanofi Pasteur | Fluzone High-Dose Quadrivalent (2023/2024) | $73.40 | 08/01/2023 – 07/31/2024 |
| 90672 | MedImmune | FluMist Quadrivalent (2023/2024) | $27.79 | 08/01/2023 – 07/31/2024 |
| 90674 | Seqirus | Flucelvax Quadrivalent (2023/2024) (Preservative Free) | $34.17 | 08/01/2023 – 07/31/2024 |
| 90682 | Sanofi Pasteur | Flublok Quadrivalent (2023/2024) (Preservative Free) | $73.40 | 08/01/2023 – 07/31/2024 |
| 90694 | Seqirus | Fluad Quadrivalent (2023/2024) (Preservative Free) | $77.36 | 08/01/2023 – 07/31/2024 |
| 90756 | Seqirus | Flucelvax Quadrivalent (2023/2024) | $32.37 | 08/01/2023 – 07/31/2024 |
| 90686 | GlaxoSmithKline | Fluarix Quadrivalent (2023/2024) (Preservative free) | $22.35 | 08/01/2023 – 07/31/2024 |
| Flulaval Quadrivalent (2023/2024) (Preservative Free) | ||||
| Sanofi Pasteur | Fluzone Quadrivalent (2023/2024) (Preservative Free) | |||
| Seqirus | Afluria Quadrivalent (2023/2024) (Preservative Free) | |||
| 90687 | Sanofi Pasteur | Fluzone Quadrivalent 0.25ml (2023/2024) | $10.44 | 08/01/2023 – 07/31/2024 |
| Seqirus | Afluria Quadrivalent 0.25ml (2023/2024) | |||
| 90688 | Sanofi Pasteur | Fluzone Quadrivalent (2023/2024) | $20.88 | 08/01/2023 – 07/31/2024 |
| Seqirus | Afluria Quadrivalent (2023/2024) |
Related Post:
