Has your billing department prepared for the upcoming 2022-2023 influenza season?
As we approach the 2022-2023 influenza season, the Centers for Disease Control and Prevention (CDC) continues to recommend flu vaccination for everyone aged 6 months and older, with the ideal timing being by the end of October. This guidance remains consistent with previous years. However, there have been modifications to the Medicare Part B payment allowances for flu vaccines.
Coding and Billing for Flu Vaccination
Contrasting CPT® Codes and Medicare Part B Payment Allowances between the 2021-2022 and 2022-2023 Influenza Seasons
| Code | Vaccine Name | Payment Allowance | |
| 2021-2022 | 2022-2023 | ||
| cpt code 90662 | Fluzone High-Dose Quadrivalent | $65.261 | $69.941 |
| cpt code 90672 | FluMist Quadrivalent | $26.876 | $26.876 |
| cpt code 90674 | Flucelvax Quadrivalent (Pres Free) | $29.940 | $32.278 |
| cpt code 90682 | Flublok Quadrivalent | $65.261 | $69.941 |
|
cpt code 90685 |
Fluzone Quadrivalent 0.25ml (Pres Free) Afluria Quadrivalent 0.25ml (Pres Free) |
$21.639 | N/A* |
| cpt code 90686 | Fluarix Quadrivalent (Pres free) Flulaval Quadrivalent (Pres Free) Fluzone Quadrivalent (Pres Free) Afluria Quadrivalent (Pres Free) |
$20.526 | $21.518 |
| cpt code 90687 | Fluzone Quadrivalent 0.25ml Afluria Quadrivalent 0.25ml |
$9.953 | $10.241 |
| cpt code 90688 | Fluzone Quadrivalent Afluria Quadrivalent |
$19.906 | $20.482 |
| cpt code 90694 | Fluad Quadrivalent (2022-2023 – Pres Free) | $66.426 | $71.682 |
| cpt code 90756 | Flucelvax Quadrivalent | $28.370 | $30.581 |
The payment allowances for influenza vaccines under Medicare Part B are typically set at 95 percent of the average wholesale price (AWP), with the exception being when the vaccine is administered in a hospital outpatient department, rural health clinic (RHC), or federally qualified health center (FQHC), in which case payments are determined based on reasonable cost.
It’s worth noting that the influenza vaccine coverage pertains to the annual flu season, spanning from August 1st to July 31st of the following year. Consequently, it’s feasible for a Medicare beneficiary to receive two fully-covered flu vaccinations within a single calendar year. For instance, if a patient receives a flu vaccine on January 5, 2022, and then again on August 29, 2022, Medicare would cover both claims.
Furthermore, it’s important to emphasize that the annual Part B deductible and coinsurance do not apply to influenza virus vaccinations