Influenza and Pneumococcal Vaccines & Reimbursement

Jurisdiction 11 Part B

Influenza and Pneumococcal Vaccines and Administration Reimbursement

The following services are paid at 100 percent of the established fee schedule amount. Coinsurance and the annual deductible do not apply.

• Influenza and pneumococcal vaccine payment allowances are updated quarterly
• Administration payment allowances are updated annually on January 1

Influenza and Pneumococcal Administration Codes and Fees:

HCPCS Codes	Description	SC: Jan 1, 2011 Amount	VA: Jan 1, 2011 Amount	WV: Jan 1, 2011 Amount	NC: Jan 1, 2011 Amount
G0008	Administration of Influenza virus vaccine	$22.11	$22.63	$21.70	$22.31
G0009	Administration of pneumococcal vaccine	$22.11	$22.63	$21.70	$22.31
G9141	Administration of Influenza A (H1N1)	$22.11	$22.63	$21.70	$22.31

Influenza Virus Vaccine National Fees Effective September 1, 2011:

CPT Codes	Description	Amount
90654	Flu vaccine no preserv, ID	$18.38
90655	Flu vaccine no preserv 6-35m	$15.71
90656	Flu vaccine no preserv 3 & >	$12.38
90657	Flu vaccine 3 yrs im	$6.65
90658*	Flu vaccine 3 yrs & > im	Invalid Code
90660	Flu vaccine nasal	$22.32
90662	Flu vacc prsv free inc antig	$30.92
HCPCS Codes	Description	Amount
Q2035	Afluria vacc, 3 yrs & >, im	$11.54
Q2036	Flulaval vacc, 3 yrs & >, im	Carrier Priced
Q2037	Fluvirin vacc, 3 yrs & >, im	$13.65
Q2038	Fluzone vacc, 3 yrs & >, im	$13.31
Q2039	Fluzone vacc, 3 yrs & >, im	Specify Drug Name May Require Invoice

*Effective January 1, 2011 CPT code 90658 is invalid for Medicare.

Pneumococcal National Fee Effective October 1, 2011:

CPT Codes	Description	Amount
90732	Pneumococcal vaccine	$57.19