SEASONAL INFLUENZA CODES & RATES 2015-16
Seasonal Influenza Vaccine & Administration Rates listed on the following Services Files:
501 (Self-pay, Medicare & Insurance), 912 (Preventive Medicaid)
INFLUENZA (FLU) Vaccine CodesCPT Code
(*non-KVP will require
a NV modifier) / Description / Rate (self pay)
(501 Service File) / Medicare
As of: 10/01/2015 – 12/31/2015
AND/OR INSURANCE
Highlighted Rates are new as of 10/01/15. / Preventive Medicaid
(912 Service File)
90630* (Not VFC Covered) / Influenza, Quad preservative free, Intradermal / 19.00 / 23.47 / (Not Currently on Medicaid Preventive Fee Schedule)
90656* / Influenza, 3yrs and above, preservative free / 15.00
(Slide and FFC) / 13.88 / 18.40
90657* / Influenza, 6-35mths / 12.00
(Slide and FFC) / 6.02 / 18.40
90658* / Influenza, 3yrs and above / 14.00
(Slide and FFC) / Medicare – See`Q’ codes
Insurance - 14.00 / 18.40
90661* / Influenza, preserv. & antibiotic free, 18 &above / 19.00 / 22.28 / 18.40
90662* / Influenza, preserv. free,
high dose, enhanced / 33.00
(Slide and FFC) / 36.32 / 18.40
90672* / Influenza, live, intranasal, FluMist, 2yrs-49yrs / 23.00
(Slide and FFC) / 26.88 / 18.40
90673* / Recombinant Influenza, 18-49yrs. / 32.75 / 37.19 / 18.40
90685* / Influenza, Quad, preservative free; 6-35 mths / 21.00 / 24.60 / 18.40
90686* / Influenza, Quad, preservative free; 3 and above / 18.00 / 18.16 / 18.40
90687* / Influenza, Quad, 6-35mths / 16.00 / 9.13 / (Not Currently on Medicaid Prev. Schedule)
90688* / Influenza, Quad, 3yrs and above / 16.00 / 18.27 / 18.40
Below MEDICARE codes (formerly 90658 code)
Q2035 / Afluria- Influenza, 9yrs and ↑ / 13.02
Q2036 / Flulaval- Influenza, 18yrs and ↑ / 8.58
Q2037 / Fluvirin- Influenza, 4yrs and ↑ / 15.83
Q2038 / Fluzone- Influenza, 3yrs and ↑ / 12.04
Q2039 / NOS flu- Influenza, 3yrs and ↑ / 10.98
(CDC private dose rate)
INFLUENZA (FLU) Administration Codes
CPT Code (non-VFC) / Description / Rate (self pay)
(501 Service File) / Medicare / Preventive Medicaid
(912 Service File)
G0008 / Flu Administration
· Medicare
· ≥19yrs
· <19yrs Not VFC and Not by Component) / (Slide) 18.00
(FFC) 26.00 / 25.51
90471 (by injection)
or
90473 (intranasal) / Flu Administration (19yrs & older)
(VFC and Not by Component)
Not VFC and by route / (Slide) 19.93
(FFC) 26.00
90460
(by Component) / Flu Administration (6mos. - <19yrs) VFC and by Component
Not VFC and by Component / (Slide) 19.93
(Slide at 19.93) or
(FFC at 26.00)
ADULT PNEUMONIA Vaccine and Administration Codes
90732 / Adult Pneumococcal , (PPSV23) / 72.00 / 82.51 / 18.40
G0009 / Adult Pneumococcal Administration / (Slide) 18.00
(FFC) 26.00 / 25.51
Rev. 10/23/15