CMS released the Influenza Vaccine Payment Allowances for flu season 2013 – 2014. The updated fees take effect August 1, 2013.
As a reminder with Medicare select the HCPCS code based on the vaccine given.
- HCPCS Q2035 (Afluria®) is $11.543 (DOS 8/1/2013-7/31/2014)
- HCPCS Q2036 (Flulaval®) is $8.579 (DOS 8/1/2013-7/31/2014)
- HCPCS Q2037 (Fluvirin®) is $14.963 (DOS 8/1/2013-7/31/2014)
- HCPCS Q2038 (Fluzone®) is $12.044 (DOS 8/1/2013-7/31/2014)
Effective August 1, 2013, HCPCS Q2039 (Flu Vaccine Adult - Not Otherwise Classified) payment allowance is to be determined by the local claims processing contractor.
Administration code for influenza for Medicare is G0008; reimbursement is based on state and locality.
Payment for the following may be made if your MAC determines its use is medically reasonable and necessary for the beneficiary:
- CPT 90654 Payment allowance is $18.918 for DOS of 8/1/2013-7/31/2014.
- CPT 90662 Payment allowance is $31.823 for DOS of 8/1/2013-7/31/2014.
- CPT 90672 Payment allowance is $24.596 for DOS of 8/1/2013-7/31/2014.
- CPT 90673 Payment allowance is pending for DOS of 1/1/2014-7/31/2014.
- HCPCS Q2033 (Flublok®) Payment allowance is pending for DOS of 8/1/2013-7/31/2014.
As the information becomes available, CMS will post payment limits for influenza vaccines that are approved after the release date of this CR (including CPT codes 90687 & 90688) on the CMS Seasonal Influenza Vaccines Pricing webpage at http://cms.gov/Medicare/Medicare-Fee-for-Service-Part-B-Drugs/McrPartBDrugAvgSalesPrice/VaccinesPricing.html on the CMS website.
Please note that the payment allowances for pneumococcal vaccines are based on 95 percent of the AWP and are updated on a quarterly basis via the Quarterly Average Sales Price (ASP) Drug Pricing Files. Further, you should be aware that annual Part B deductible and coinsurance amounts do not apply. All physicians, non-physician practitioners, and suppliers who administer the influenza virus vaccination and the pneumococcal vaccination must take assignment on the claim for the vaccine.
To read more see MLN Matters 8843
The official instruction, CR 8433 issued to your MAC regarding this change may be viewed at http://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R2786CP.pdf