Billing Flu Shots to Medicare and Commercial Insurance Companies

Since it is now flu season I have been getting a lot of questions on how to bill flu shots to commercial insurance companies and Medicare. The codes used for a particular vaccine will vary depending on intramuscular vs. intranasal use, age of the patient, formulation, preservative-free, and split or live virus. If you are unsure of what code to use I suggest looking at the package information
that came with the vaccine. Usually, you can find the code on the packaging, and if you can’t find it in the documentation then call the supplier.

This is how most of our primary care practices bill for flu shots. Your situation may be different so make sure to check all the influenza vaccine codes 90654-90668 and use the appropriate code for the vaccine administered to the patient.

Commercial Insurance Carriers

• 90471 Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 vaccine (single or combination vaccine/toxoid)
• 90658 Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use

Medicare

• G0008 Administration of Influenza Virus Vaccine
• Q203x Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use

Keep in mind that there are several codes for the flu vaccine when you bill for Medicare flu shots. The code you use is dependent on the manufacturer of the vaccine. Replace the code above with the correct vaccine code below.

Here is the list of the Medicare Flu Vaccine codes. Choose the code based on the manufacture:

• Q2034 Agriflu Vaccine: Influenza virus vaccine, split virus, for intramuscular use (Agriflu)

• Q2035 Afluria Vaccine: Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Afluria)

• Q2036 Flulaval Vaccine: Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Flulaval)

• Q2037 Fluvirin Vaccine: Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Fluvirin)

• Q2038 Fluzone Vaccine: Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Fluzone)

• Q2039 NOS (Not Otherwise Specified) Vaccine: Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Not Otherwise Specified)

Check out the short video we made about coding for the Medicare flu shot CLICK HERE

Pediatric Billing

If a child is under the age of 9 and has not previously received a flu shot, then usually two shots are given one month apart. After the initial series, in subsequent years only one shot is needed. When billing for the initial flu shot keep in mind that insurance should pay for both the initial flu shot and the flu shot given 30 days later. Be sure to follow up with the insurance companies if reimbursement is not issued for the second shot of the initial series. Typically these are denied but can be paid with a simple appeal or phone call correcting the denial.

90471 Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 vaccine (single or combination vaccine/toxoid)

Use the age-appropriate codes as needed:

• 90657 Influenza virus vaccine, split virus, when administered to children 6-35 months of age, for intramuscular use

Or

• 90658 Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use

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Do you know the new CPT codes for billing the Coronavirus Vaccine and administration fees? Check out my CPT Codes for Coronavirus Vaccine post.

--- This post How to Bill Flu Shots was written by Manny Oliverez and first appeared on CaptureBilling.com - Medical Billing Services. Capture Billing is a medical billing company helping medical practices get their insurance claims paid faster, easier and with less stress allowing doctors to focus on their patients.