Last Updated: Aug 31, 2017
A new influenza virus vaccine code will be payable by Medicare effective for claims processed with dates of service on or after Jan. 1, 2018.
The vaccine code 90756 is for influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, antibiotic free, 0.5mL dosage, for intramuscular use. It will be included on upcoming 2018 Medicare Physician Fee Schedule and Healthcare Common Procedure Coding System (HCPCS) updates.
Claims For Dates of Services Prior to Jan. 1, 2018
During the interim period of Aug. 1-Dec. 31, 2017, Medicare Administrative Contractors (MACs) used the active code Q2039 – influenza virus vaccine, not otherwise specified – to handle bills for the new vaccine product. To determine payment rates, MACs will use CMS' seasonal influenza vaccines pricing website.
Keep in mind that claims using the new code 90756 will not be accepted for dates of service on or before Dec. 31, 2017. CMS emphasizes that claims received in January 2018 with code 90756 for dates of service between Aug. 1 and Dec. 31, 2017, will be rejected or returned.
CMS offers these MLN Matters online articles with more details on influenza vaccines:
Pennsylvania Medical Society (PAMED) members with questions can also contact our Knowledge Center at 855-PAMEAD4U (855-726-348) or KnowledgeCenter@pamedsoc.org.