Posts Tagged ‘vaccine’

2013/2014 Flu Vaccine Information

In Uncategorized on August 23, 2013 at 6:05 pm

The Centers for Disease Control has announced the following information regarding ordering the 2013-2014 flu vaccine:

The 2013-2014 influenza vaccine can be ordered at this time from manufacturers and distributors.

As the 2012-2013 flu season has shown, it is important to pre-book vaccine as soon as it is available. Most of the flu vaccine offered for the 2013-2014 season will be trivalent (three component).

  • Trivalent vaccine offers important protection from flu.
  • Some quadrivalent (four-component) vaccine will be available as well according to manufacturers; however, supplies are expected to be limited.
  • All nasal spray vaccine is expected to be quadrivalent, however, this makes up only a small portion of total vaccine availability.
  • Ordering flu vaccine should not be delayed if quadrivalent flu vaccine is not available.

More information is available on the CDC website.


CMS Issued A Vaccine Update 3/21/13

In Uncategorized on August 23, 2013 at 5:57 pm

Recall my discussion in a prior post of CMS’ refusal to cover tetanus (or other vaccines, other than the annual influenza vaccine, the once per lifetime pneumococcal vaccine, and the high-risk patient’s hepatitis-B vaccine) as a medically necessary vaccination absent an incident of exposure?  Well, in spring of 2013, CMS clarified their position.

To report the tetanus vaccine administered for the treatment of an injury or direct exposure to a disease or condition, append modifier AT (acute treatment) to the code for the vaccine.  Claims submitted without modifier AT will be denied.

 Note: The medical record must support the need for the service and the use of modifier AT.

Vaccinations or inoculations are excluded as immunizations unless they are directly related to the treatment of an injury or direct exposure to a disease or condition, such as anti-rabies treatment, tetanus antitoxin or booster vaccine, botulin antitoxin, antivenin sera, or immune globulin. In the absence of injury or direct exposure, preventive immunization is not covered. However, pneumococcal, hepatitis B, and influenza virus vaccines are exceptions to this rule.  See, The Centers for Medicare and Medicaid Services Benefit Policy Manual, 100-02, Chapter 15, Section

Remember, patients demanding a vaccine absesnt an acute incident or exposure need to be presented with and execute a valid Advanced Beneficiary Notice (ABN) in order for the practice to be able to bill that patient once Medicare denies the claim.

Vaccine Coverage Reminder… What Do Medicare Preventative Services Cover?

In Uncategorized on August 22, 2013 at 9:03 pm

MEDIC wants to remind its providers that the following vaccines are the only ones that are automatically covered under Medicare’s preventative services:

  • The flu vaccine is covered on an annual basis,
  • The pneumococcal vaccine is covered once per lifetime, and
  • The hepatitis-B vaccine is covered in the event that a patient is deemed/falls into a high risk category

Other vaccines are covered only based on patient exposure.  Examples of vaccines that receive coverage based on exposure are: tetanus, rabies, botulin, antivenin or immune globulin.  For any of these exposure-based vaccines, providers should have patients complete an ABN (Advanced Beneficiary Notice – see — at the bottom of the page, there are downloads from which you can   access the current ABN) to ensure collection of monies for these otherwise routine vaccines. 

In speaking with billing staff, we have deduced that the majority of patient calls/questions are regarding the tetanus vaccine, so to reiterate:  if a patient suffers an injury, then Medicare will cover the tetanus vaccine; however, absent an injury (i.e., a routine administration), that vaccine will not be covered.

Finally, please note that the Zoster vaccine for shingles is a Medicare Part B non-covered service, which will require an ABN in order to be able to bill the patient.  Patients may have Part D coverage or a secondary that will cover it, but that is a case-by-case coverage analysis, and not necessarily the norm.  

 Please feel free to contact MEDIC if you have any questions relating to this issue of vaccine coverage.

Coding & Billing Medicare Influenza Vaccines – Q Code Selection

In Uncategorized on October 12, 2011 at 1:14 pm

As 2011 is drawing to a close, and new coding guidelines are being published and disseminated, M.E.D.I.C., Inc. wanted to take this opportunity to alert you to updates regarding seasonal influenza vaccine pricing.  As of September 1, 2011, payment allowances for flu vaccines have changed. 

In 2011, CMS stopped accepting CPT code range 90654-90662 for the influenza vaccine (note that commercial carriers still accept them, but Medicare will not).  Rather, those codes have been replaced by a series of Q codes which relate to the brand name of the vaccine:  Q2035 relates to Afluria; Q2036 relates to Flulavel; Q2037 relates to Fluvirin; Q2038 relates to Fluzine; and Q2039 relates to those not otherwise specified… all are defined as “Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use.”

Per CMS (, the pricing allowance from September 1st, 2011 through August 31st, 2012 will be as follows:  95% of the Average Wholesale Price, as listed below: 

  • Q2035 (Afluria): $11.543
  • Q2036 (Flulaval): $8.784
  • Q2037 (Fluvirin): $13.652
  • Q2038 (Fluzone): $13.306
  • Q2039 (N.O.S.): locally priced

Because the compensation differs for each product, providers must be sure to alert their billing staff/billing company to the specific brand of flu vaccine that is being administered to patients, so that they can ensure that claims are submitted to Medicare with the appropriate corresponding code.  In the event that the Q2039 “not otherwise specified” code is used, the claim will likely be denied, and additional information in the form of visit notes will be sought.  So, please – be sure to provide the brand specificity at the outset to ensure efficient processing and payment of your claims.

Furthermore, in addition to the Q codes, the HCPCS code G0008 for the Administration of the Influenza Vaccine must still be used for the administration of the flu vaccine for all Medicare patients.

Annual Part B deductible and coinsurance amounts do not apply for the influenza virus and the pneumococcal vaccinations. 

All physicians, non-physician practitioners, and suppliers who administer these vaccinations must take assignment on the claim for the vaccine.

When billing flu shots to commercial carriers (i.e., non-Medicare), the Q codes are not applicable.  Practices will generally  code the following (but remember, the code used will depend on the route of administration (intramuscular vs. intranasal), the age of patient, the formulation, and whether the vaccine is preservative free, and split or live virus — each of which relate to influenza vaccine codes 90654-90668):

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