Time to make sure your practice is current on the 2021-2022 codes and payment allowances for flu vaccine and administration.
With the novel coronavirus continuing to circulate and cause severe illness in the United States and worldwide, getting a flu shot is once again more important than ever. The 2021–22 influenza season will coincide with the continued circulation of SARS-CoV-2, the virus that causes COVID-19, so start planning now.
Common signs and symptoms of COVID-19 (e.g., dyspnea, fever, and cough) can also occur with influenza, which is one of the many reasons why the Centers for Disease Control and Prevention (CDC) recommends that everyone six months and older receive a flu shot. Influenza vaccines provide the best protection against the flu and its potentially serious complications. Furthermore, getting the jab will decrease the prevalence of the flu as well as reduce symptoms that might be confused with those of COVID-19. Make sure your practice is prepared for the flux of injections by updating your billing systems with the 2021 Average Sales Price (ASP) Drug Pricing Files and reading the latest vaccination guidance.
Vaccine Codes, Payment Allowances, Billing Guidelines
CPT® coding for vaccinations involves two codes, one for the vaccine and one for its administration. The table below breaks down the vaccine codes and payment allowances for the 2021-2022 season. These payment allowances are effective Aug. 1, 2021, through July 31, 2022. Download the 2021 Average Sales Price (ASP) Drug Pricing Files for up-to-date pricing information on all Medicare Part B drugs.
|Code||Vaccine Name (2021/2022)||Labeler Name||Payment Allowance|
|90662||Fluzone High-Dose Quadrivalent||Sanofi Pasteur||$65.261|
|90674||Flucelvax Quadrivalent (Pres Free)||Seqirus||$29.940|
|90682||Flublok Quadrivalent||Sanofi Pasteur||$65.261|
|90685||Fluzone Quadrivalent 0.25ml (Pres Free)|
Afluria Quadrivalent 0.25ml (Pres Free)
|90686||Fluarix Quadrivalent (Pres free)|
Flulaval Quadrivalent (Pres Free)
Fluzone Quadrivalent (Pres Free)
Afluria Quadrivalent (Pres Free)
|90687||Fluzone Quadrivalent 0.25ml|
Afluria Quadrivalent 0.25ml
The Medicare Part B payment allowance limits for seasonal influenza vaccines are 95 percent of the Average Wholesale Price (AWP). Payment for the vaccine is based on reasonable cost when the job is furnished in a hospital outpatient department.
Medicare pays for one seasonal influenza virus vaccination per influenza season. Annual Part B deductible and coinsurance amounts do not apply for influenza vaccinations. All physicians, non-physician practitioners, and suppliers who administer these vaccines must take assignment on the claim for the vaccine.
Flu Vaccine Administration Coding
When reporting vaccination encounters, use ICD-10-CM diagnosis code Z23 Encounter for immunization. For Medicare, code the administration of the flu shot with G0008 Administration of influenza virus vaccine.
Most vaccines are given as injections and are reported to non-Medicare payers with administration codes
- 90471 Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 vaccine (single or combination vaccine/toxoid); and
- +90472 Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); each additional vaccine (single or combination vaccine/toxoid) (List separately in addition to code for primary procedure).
But there are a few oral and intranasal vaccines that are reported using administration codes 90473 and 90474. Only use 90471-90474 when immunization is not accompanied by face-to-face counseling of the patient/family, or for vaccine administration to patients over 18 years of age.
Pediatric vaccine administration with counseling codes are:
- 90460 Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; first or only component of each vaccine or toxoid administered
- +90461 Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; each additional vaccine or toxoid component administered (List separately in addition to code for primary procedure)
What Do Experts Recommend?
“Routine annual influenza vaccination is recommended for all persons aged ≥6 months who do not have contraindications,” per the CDC. The American Academy of Pediatrics (AAP) also recommends annual influenza immunization of all children without medical contraindications, starting at 6 months of age.
“Influenza vaccination is an important intervention to protect vulnerable populations and reduce the burden of respiratory illnesses during circulation of severe acute respiratory syndrome coronavirus 2, which is expected to continue during the 2021–2022 influenza season.” -AAP
AAP maintains that any licensed, age-appropriate vaccine is acceptable; they do not have a preference for one product or formulation over another. Notably, the AAP clarifies that the flu jab “may be administered simultaneously with or any time before or after administration of the currently available novel coronavirus disease 2019 (COVID-19) vaccines.”
What’s Going Around This Year?
All seasonal influenza vaccines expected to be available for the 2021–2022 season are quadrivalent, containing hemagglutinin (HA) derived from one influenza A(H1N1)pdm09 virus, one influenza A(H3N2) virus, one influenza B/Victoria lineage virus, and one influenza B/Yamagata lineage virus.
For the 2021–22 season, U.S.-licensed influenza vaccines will contain:
- A/Victoria/2570/2019 (H1N1)pdm09-like virus (for egg-based vaccines) or an influenza A/Wisconsin/588/2019 (H1N1)pdm09-like virus (for cell culture–based and recombinant vaccines);
- A/Cambodia/e0826360/2020 (H3N2)-like virus;
- B/Washington/02/2019 (Victoria lineage)-like virus; and
- B/Phuket/3073/2013 (Yamagata lineage)-like virus.
For further clarification, see the recommendations of the Advisory Committee on Immunization Practices (ACIP) regarding prevention and control of seasonal influenza with vaccines.