Medical Billing Tips: Coding for Medicare Flu Shots

Health Insurance Companies Process 1 in 5 Claims Wrong

Video | Billing for Medicare Flu Shots

Medical Billing Tips discusses the Medicare coding changes for billing influenza vaccine using Q codes that started back on January 1, 2011. The Q codes for flu vaccine include Q2035, Q2036, Q2037, Q2038 and Q2039. Contact CMS for more details.

Medical Billing Tips Video Transcript

Hi, my name is Manny Oliverez, Director of Operations at Capture Billing and you medical billers know how to bill flu shots, but what you may not know is that on January 1, 2011, CMS (Medicare) changed the rules. No longer do you bill Medicare patients with 90658 for the flu shot. Now there’s a whole new set of new codes.

So for example, what happens when your Medicare patient comes in for their flu shot: Well no longer are you going to be using 90658, now you have to use Q codes. Q2035, or Q2036. Q2037, Q2036, Q2039.

Why can’t we use these anymore? Because Medicare and the federal government now want to know exactly what it is being injected into the patients arm. These codes are brand specific. Each one of these Q codes represent a different manufacture of the flu vaccine, so now by reporting the Q codes you’re reporting to Medicare exactly what brand of vaccine you used and gave to the Medicare patient.

Now for more information on this you can do a Google search on CMS, Medicare, Q codes, or go to the CMS website or to your local CMS carrier.

And as always remember a medical practice is a business treat it as such.

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9 Responses to “Medical Billing Tips: Coding for Medicare Flu Shots”

  1. Hello Mr Oliverez

    We did a Highdose flu shot Nov 2017 on a United Healthcare Dual complete inwhich is Medicare and Medicaid I originally billed the new 90653 and they are telling me its not a covered CPT so I changed it to 90662 and rebilled it showing corrected claim. They still continue to deny not covered. What is wrong with this can you help.
    Thanks
    Karen

    Reply
  2. I cannot figure out why Medicare is denying all of our Medicare flu shots. We have Fluzone so I am using Q2038 and G0009 along with DX Z23. The NDC number is attached. I believe one denial stated something about the description, ours is Influenza Virus Vaccine (Fluzone. Am I missing something? Thanks.

    Reply
    • Hi Jennifer —

      G0009 is for the administration of the pneumococcal vaccine. G0008 is for the administration of the influenza virus vaccine. Unless that was just a typo in this post that could be your issue. Q2038 is the correct code for Fluzone and the DX of Z23 is what we use, so that looks fine. –Manny

      Reply
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    Reply
  4. Hi I am a Medical Biller at a Physicians office in Mississippi which is new to me being that my prior billing experience was Dialysis in the state of Georgia. Now I am finding that billing state to state and specialty to specialty is very different. I have found this site to be very helpful.
    Thanks
    Pamela

    Reply
    • Hi Pamela —

      Thanks for your comment. We can do billing in all 50 states and work with multiple specialties and you are correct, each state is different. As long as you have the billing principles down, know how to find the information and ask the right questions you will do great. –Manny

      Reply
  5. Showing appreciation for posting this. I like how you have presented your information in outstanding detail.

    Reply
    • For Fluzone High-Dose (IIV3) 0.5 mL (single-dose syringe) 65 years & older the CPT code is 90662.

      Check with the vaccine manufacture for additional information on how to bill the vaccine. They usually have good info becasue they want you to get paid and order more from them.

      Reply
  6. Can you bill a flu vaccine along with an office visit for a Medicare patient and if so…what modifier must be used?

    Reply
    • Melissa you can bill an office visit for a problem unrelated to the flu shot. For example a patient comes in for an injury and the doctor orders a flu shot while they are in the office but you can’t have an office visit just for a flu shot. Use code G0008, Administration of influenza virus vaccine, along with the appropriate vaccine CPT code. No modifier is needed.

      Reply

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