This is what has been released so far for non-Medicare flu shots – as soon as I hear about Medicare I will post it.

The FDA approval pending indicator is removed from code 90661 following the November 20, 2012 notification that this product has been granted FDA approval status.

- 90661
Influenza virus vaccine, derived from cell cultures, subunit, preservative and antibiotic free, for intramuscular use
Published in CPT 2008

Codes 90685, 90686, 90687, 90688 were accepted at the May 2012 CPT Editorial Panel meeting for the 2014 CPT book production cycle. The FDA approval pending indicator is removed from code 90686 following the December 14, 2012 notification that this product has been granted FDA approval status.

– 90685
Influenza virus vaccine, quadrivalent, split virus, preservative free, when administered to children 6-35 months of age, for intramuscular use, Released July 1, 2012, Implementation January 1, 2013, CPT 2014
– 90686
Influenza virus vaccine, quadrivalent, split virus, preservative free, when administered to individuals 3 years of age and older, for intramuscular use, Released July 1, 2012, Implementation January 1, 2013, CPT 2014
– 90687
Influenza virus vaccine, quadrivalent, split virus, when administered to children 6-35 months of age, for intramuscular use
Released July 1, 2012, Implementation January 1, 2013, CPT 2014
– 90688
Influenza virus vaccine, quadrivalent, split virus, when administered to individuals 3 years of age and older, for intramuscular use
Released July 1, 2012, Implementation January 1, 2013, CPT 2014

Best wishes,

Mary Pat

What has Medicare released on reimbursement for the new Fluarix (Quad) vaccine by GSK?

Thanks!
Donya

Is your diagnosis supporting the medical necessity of the booster? You need to make sure your diagnosis supports the reason for the booster.

Best wishes,

Mary Pat

Medicare is denying q2036 due to payer deems the info submitted does not support this many/frequency o services. If we adminstered as a booster how can we appeal or correc claim?

Have you contacted Medicaid and asked for a reason? What does the denial code on the Medicaid EOB state?

Best wishes,

Mary Pat

Lately medicaid is not paying for our flu shots for adults we are billing 90658. We have tried Q2036 and still there is a denial with the NDC. Any suggestions?

Unless a separate E/M service has been provided, there is no facility fee associated with giving a flu shot.

Best wishes,

Mary Pat

The best approach is to call the Medicare replacement plan and ask them what they want. Some Medicare replacement plans will take either/or, but some are very definitive about what they want.

Best wishes,

Mary Pat