9/29/2012 Medicare pricing just released for flu shots – see pricing added to the codes below.
Download this excellent 2012 – 2013 grid that shows vaccines by name and the appropriate codes!
NOTE: Practices using FLUARIX (preservative free) for Medicare patients should be using 90656 and not the NOS code of Q2039.
Q2034 Introduced As New Medicare Reimbursement Code for 2012 – 2013 Flu Shot Season
Influenza virus vaccine code Q2034 (Influenza virus vaccine, split virus, for intramuscular use (Agriflu)) for claims with dates of service on or after July 1, 2012, processed on or after October 1, 2012 has been introduced for the 2012 – 2013 flu season for Medicare patients.
Effective for claims with dates of service on or after July 1, 2012, influenza virus vaccine code Q2034 will be payable by Medicare. Annual Part B deductible and coinsurance amounts do not apply. All physicians, non-physicians practitioners and suppliers who administer the influenza virus vaccination must take assignment on the claim for the vaccine.
Effective for dates of service between July 1, 2012 and September 30, 2012, contractors shall use local pricing guidelines to determine payment rates for influenza virus vaccine code Q2034.
Contractors shall pay for influenza virus vaccine code Q2034 to hospitals (12X and 13X), SNFs (22X and 23X), HHA (34X), hospital-based RDFs (72X), and CAHs (85X) based on reasonable cost.
Until systems are implemented, contractors shall hold institutional claims containing code Q2034 with dates of service on or after July 1, 2012, received before October 1, 2012.
Once the system changes described in this instruction are implemented, contractors shall release the held claims, appending condition code 15.