Seasonal Influenza Codes & Rates 2012

SEASONAL INFLUENZA CODES & RATES 2012

Seasonal Influenza Vaccine & Administration Rates listed on the following Services Files:

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

INFLUENZA (FLU) Vaccine Codes
CDPT Code
(*non-KVP will require
a NV modifier) / Description / Rate (self pay)
(501 Service File)
Rev. rates 8/1/12 / Medicare
Rev. rates
(eff. 8/1/2012) / Preventive Medicaid
(912 Service File) / Passport Health Plan
(903 Service File)
Rev. 10/23/12,
PHP eff. date 10/1/12
90654*
(not VFC covered) / Influenza, 18-64yrs, intradermal, preserv. free / 16.00 17.00
(Slide and FFC) / 18.38 18.98 / 18.40
(New) / (<19yrs) $18.40
(≥19yrs) 37.38
90655* / Influenza, 6-35mths,
preservative free / 13.00 15.00
(Slide and FFC) / 15.71 16.45 / 18.40 / 18.40
90656* / Influenza, 3yrs and above, preservative free / 14.00
(Slide and FFC) / 12.38 12.39 / 18.40 / (<19yrs) 18.40
(≥19yrs) 30.08
90657* / Influenza, 6-35mths / 11.00
(Slide and FFC) / 6.65 6.02 / 18.40 / 18.40
90658* / Influenza, 3yrs and above / 12.00
(Slide and FFC) / . / 18.40 / (3yrs - <19yrs) 18.40
(19yrs - <65yrs) 29.77
90660* / Influenza, live, intranasal / 20.00 21.00
(Slide and FFC) / 22.32 23.45 / 29.14 / (<19yrs) 18.40
(≥ 19yrs) 41.86
90662 / Influenza, preserv. free,
high dose, enhanced / 30.00
(Slide and FFC) / 30.92 / 18.40 / 30.92
Below MEDICARE codes (formerly 90658 code)
Q2034 / Agriflu-Influenza, 3yrs and ↑ / 14.00
(CDC private dose rate)
Q2035 / Afluria- Influenza, 3yrs and ↑ / 11.54
Q2036 / Flulaval- Influenza, 3yrs and ↑ / 8.79 9.83
Q2037 / Fluvirin- Influenza, 3yrs and ↑ / 13.65 14.05
Q2038 / Fluzone- Influenza, 3yrs and ↑ / 13.31 12.04
Q2039 / NOS flu- Influenza, 3yrs and ↑ / 10.98
(CDC private dose rate)
INFLUENZA (FLU) Administration Codes
CDPT Code (non-VFC) / Description / Rate (self pay)
(501 Service File) / Medicare / Preventive Medicaid
(912 Service File) / Passport Health Plan
(903 Service File)
G0008 / Flu Administration
·  Medicare
·  ≥19yrs
·  <19yrs Not VFC and Not by Component) / (Slide) 18.00
(FFC) 22.00 / 21.85 / .
90471 (by injection)
or
90473 (intranasal) / Flu Administration (6mos. - <19yrs)
(VFC and Not by Component)
Not VFC and by route / (Slide) 14.17
(FFC) 22.00 / .
90460
(by Component) / Flu Administration (6mos. - <19yrs) VFC and by Component
Not VFC 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 62.00 / 57.19 / 18.62 / (<19yrs) 18.40
(≥19yrs) 32.70 / .
G0009 / Adult Pneumococcal Administration / (Slide) 18.00
(FFC) 22.00 / 21.85

Revised: 8/1/12