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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.

is a 20 year veteran of healthcare having managed medical practices. He advises medical practices, physicians and practice administrators on how to run their practice and manage their medical billing and revenue cycle management. Manny speaks, blogs and makes videos at www.CaptureBilling.com, a blog that is tops in the medical billing and coding field. READ MORE

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11 Responses to Medical Billing Tips: Coding for Medicare Flu Shots

  1. 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.

    • 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

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  3. 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.

    • 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

    • 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.

    • 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.

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The analysis of any medical billing or coding question is dependent on numerous specific facts -- including the factual situations present related to the patients, the practice, the professionals and the medical services and advice. Additionally, laws and regulations and insurance and payer policies (as well as coding itself) are subject to change. The information that has been accurate previously can be particularly dependent on changes in time or circumstances. The information contained in this web site is intended as general information only. It is not intended to serve as medical, health, legal or financial advice or as a substitute for professional advice of a medical coding professional, healthcare consultant, physician or medical professional, legal counsel, accountant or financial advisor. If you have a question about a specific matter, you should contact a professional advisor directly. CPT copyright American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.

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