Seasonal Influenza Codes & Rates 2011

SEASONAL INFLUENZA CODES & RATES 2011

Seasonal Influenza Vaccine & Administration Rates as of August 2011 as listed on the following Services Files:

501 (Self-pay, Medicare & Insurance), 912 (Preventive Medicaid), 903 (Passport Health Plan), and 907 (Passport Advantage)

INFLUENZA (FLU) Vaccine Codes
CDPT Code
(*non-KVP will require a NV modifier) / Description / Rate (self pay)
(501 Service File) / Medicare
(9/1/2011 through 8/31/2012) / Preventive Medicaid
(912 Service File) / Passport Health Plan
(903 Service File)
Rev. 9/26/11 / Passport Advantage
(907 Service File)
90654NV
added 8/24/11 / Influenza, 18-64yrs, intradermal, preserv. free / 16.00
(Slide and FFC) / 18.38
(new 9/26/11, eff. 9/1/11) / Should pay the same as Medicare
90655* / Influenza, 6-35mths,
preservative free / 13.00
(Slide and FFC) / 14.8615.71
(rev. 9/26/11, eff. 9/1/11) / 18.40 / 18.40 / Should pay the same as Medicare
90656* / Influenza, 3yrs and above, preservative free / 14.00
(Slide and FFC) / 12.38 / 18.40 / (<19yrs) 18.40
(≥19yrs) 23.2230.78 / (3-<19yrs) 12.75
(≥19yrs) N/A
(listed on PAD fee schedule)
90657* / Influenza, 6-35mths / 11.00
(Slide and FFC) / 6.306.65
(rev. 9/26/11, eff. 9/1/11) / 18.40 / 18.40 / Should pay the same as Medicare
90658* / Influenza, 3yrs and above / 12.00
(Slide and FFC) / . / 18.40 / (3yrs - <19yrs) 18.40
(19yrs - <65yrs)18.2229.77 / Should pay the same as Medicare
90660* / Influenza, live, intranasal / 20.00
(Slide and FFC) / 22.32 / 29.14 / (<19yrs) 18.40
(≥ 19yrs) 27.5040.72 / Should pay the same as Medicare
90662 / Influenza, preserv. free,
high dose, enhanced / 30.00
(Slide and FFC) / 29.2130.92
(rev. 9/26/11, eff. 9/1/11) / 18.40 / Should pay the same as Medicare
Below MEDICARE codes (formerly 90658 code) revised 9/7/11
Q2035 / Afluria- Influenza, 3yrs and ↑ / 11.0011.54
(rev. 9/26/11, eff. 9/1/11) / Should pay the same as Medicare
Q2036 / Flulaval- Influenza, 3yrs and ↑ / 8.79 / Should pay the same as Medicare
Q2037 / Fluvirin- Influenza, 3yrs and ↑ / 13.2513.65
(rev. 9/26/11, eff. 9/1/11) / Should pay the same as Medicare
Q2038 / Fluzone- Influenza, 3yrs and ↑ / 12.5913.31
(rev. 9/26/11, eff. 9/1/11) / Should pay the same as Medicare
Q2039 / NOS flu- Influenza, 3yrs and ↑ / 10.98
(CDC private sector dose rate) / Should pay the same as Medicare
INFLUENZA (FLU) Administration Codes
CDPT Code (non-VFC) / Description / Rate (self pay)
(501 Service File) / Medicare
(through
August 31, 2011) / Preventive Medicaid
(912 Service File) / Passport Health Plan
(903 Service File) / Passport Advantage
(907 Service File)
G0008 / Flu Administration

• Medicare
• ≥19yrs
• <19yrs Not KVP and Not by Component)

/ (Slide) 18.00
(FFC) 22.00 / 21.85 / 22.51
(listed on PAD fee schedule)
90471 (injection)
or
90473 (intranasal)
added 8/24/11 / Flu Administration (6mos. - <19yrs)
(KVP and Not by Component) / (Slide) 14.17
(FFC) 22.00 / .
90460 / Flu Administration (6mos. - <19yrs) KVP and by Component
Not KVP and by Component / (Slide) 14.17
(Slide at 14.17) or
(FFC at 22.00)
ADULT PNEUMONIA Vaccine and Administration Codes
90732 / Adult Pneumococcal , (PPSV23) / 48.97
Revised 9/7/11 based on CDC private sector per dose / 57.19
(Medicare Part B payment allowance limit thru 9/30/11) / 18.62 / (<19yrs) 18.40
(≥19yrs) 32.70 / 51.22
(listed on PAD fee schedule)
G0009 / Adult Pneumococcal Administration / (Slide) 18.00
(FFC) 22.00 / 21.85 / 22.51
(listed on PAD fee schedule)

Revised: 9/7/11