Preventive Services

Preventive Services Guide

Influenza Virus Vaccine and Administration

Influenza (flu) is a contagious respiratory illness caused by the influenza virus that causes mild to severe illness. According to the CDC, millions of people get the flu every year; serious outcomes can result in hospitalization or death. For Medicare billing purposes, the flu season runs from August to July of the following year.

Table of Contents

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Coverage Criteria

  • All Medicare beneficiaries are covered for one flu shot per flu season
    • More than one per season may be covered if medically necessary

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Billing Tips

  • The NDC must be included in Loop 2410 LIN segments of the electronic claim, Item 19 on the CMS-1500 paper claim.
    • Each box of vaccine includes the NDC assigned by the manufacturer
    • The NDCs change each influenza season
  • Submit single claims electronically unless provider is approved under ASCA exception waiver
    • ASCA exceptions include:
      • Small providers, certain mass immunizers, providers who submit fewer than ten claims per month on an average during a calendar year
  • Roster claims may be submitted electronically or on paper
  • As a reminder, please review and use the appropriate flu shot code to avoid processing delays and claim denials on the CMS Seasonal Influenza Vaccines Pricing web page.
  • Pricing information for the G0008 administration code is located on the Vaccines and Administration Pricing section of the​​​ Fee Schedule Lookup web page under the Admin for Flu/PPV/Hepatitis Fee Schedules section.

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Roster Billing

  • Streamlined process for submitting vaccination claims for large groups of individuals
    • All patients have the same service
    • Not used for single patient billing
  • Patient roster form includes the following with a single modified CMS-1500 claim form as roster cover document for each facility where the services are rendered:
    • Patients name, address, Medicare number, date of birth and gender
    • Date of service
    • Beneficiary signature or stamped “Signature on File”
    • Providers name and identification number
    • Control number for contractor
  • Immunization Roster Billing

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Mass Immunizers

  • Must be properly licensed in the state in which they plan to operate flu clinics
  • Enrollment is ongoing and completed through the local A/B MAC
    • Participation is limited to one year, must be renewed annually via the CMS Central Office by June 1st
  • Must use roster billing process and bill to local MAC
  • Offer shots to a large number of individuals
  • Must accept assignment on the shot and administration
  • Annual Influenza Vaccine Season Starts on August 1 and Ends on July 31 of the Following year.

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Payment Allowances and Effective Dates for the 2023-2024 Flu Season

Code Labeler Name Drug Name Payment Allowance Effective Dates
90662 Sanofi Pasteur Fluzone High-Dose Quadrivalent (2023/2024) $73.403 8/1/2023‒7/31/2024
90672 MedImmune FluMist Quadrivalent (2023/2024) $27.788 8/1/2023‒7/31/2024
90674 Seqirus Flucelvax Quadrivalent (2023/2024) (Preservative Free) $34.172 8/1/2023‒7/31/2024
90682 Sanofi Pasteur Flublok Quadrivalent (2023/2024) (Preservative Free) $73.403 8/1/2023‒7/31/2024
90686 GlaxoSmithKline

Sanofi Pasteur

Seqirus		 Fluarix Quadrivalent (2023/2024) (Preservative free)

Flulaval Quadrivalent (2023/2024) (Preservative Free)

Fluzone Quadrivalent (2023/2024) (Preservative Free)

Afluria Quadrivalent (2023/2024) (Preservative Free)		 $22.350 8/1/2023‒7/31/2024
90687 Sanofi Pasteur

Seqirus		 Fluzone Quadrivalent 0.25ml (2023/2024)
Afluria Quadrivalent 0.25ml (2023/2024)		 $10.439 8/1/2023‒7/31/2024
90688 Sanofi Pasteur
Seqirus
 		 Fluzone Quadrivalent (2023/2024)
Afluria Quadrivalent (2023/2024)		 $20.878 8/1/2023‒7/31/2024
90694 Seqirus Fluad Quadrivalent (2023/2024) (Preservative Free) $77.359 8/1/2023‒7/31/2024
90756 Seqirus Flucelvax Quadrivalent (2023/2024) $32.374 8/1/2023‒7/31/2024

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Payment Allowances and Effective Dates for the 2022-2023 Flu Season

Code Labeler Name Vaccine Name Payment Allowance Effective Dates
90662 Sanofi Pasteur Fluzone High-Dose Quadrivalent (2022/2023) $ 69.941 8/1/2022 – 7/31/2023
90672 MedImmune FluMist Quadrivalent (2022/2023) $ 26.876 8/1/2022 – 7/31/2023
90674 Seqirus Flucelvax Quadrivalent (2022/2023) (Preservative Free) $ 32.278 8/1/2022 – 7/31/2023
90682 Sanofi Pasteur Flublok Quadrivalent (2022/2023) (Preservative Free) $ 69.941 8/1/2022 – 7/31/2023
90686 GlaxoSmithKline
Sanofi Pasteur
Seqirus		 Fluarix Quadrivalent (2022/2023) (Preservative Free)
Flulaval Quadrivalent (2022/2023) (Preservative Free)
Fluzone Quadrivalent (2022/2023) (Preservative Free)
Afluria Quadrivalent (2022/2023) (Preservative Free)		 $ 21.518 8/1/2022 – 7/31/2023
90687 Sanofi Pasteur
Seqirus		 Fluzone Quadrivalent 0.25ml (2022/2023)
Afluria Quadrivalent 0.25ml (2022/2023)		 $ 10.241 8/1/2022 – 7/31/2023
90688 Sanofi Pasteur
Seqirus		 Fluzone Quadrivalent (2022/2023)
Afluria Quadrivalent (2022/2023)		 $ 20.482 8/1/2022 – 7/31/2023
90694 Seqirus Fluad Quadrivalent (2022/2023) (Preservative Free) $ 71.682 8/1/2022 – 7/31/2023
90756 Seqirus Flucelvax Quadrivalent (2022/2023) $ 30.581 8/1/2022 – 7/31/2023

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For the most up to date list of billing codes, payment allowances and effective dates for the 2023-2024 flu season, please see Seasonal Influenza Vaccines Pricing.

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Diagnosis Coding

  • ICD-10 Codes

Cost Sharing

  • Copayment/coinsurance waived
  • Deductible waived

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Reimbursement

  • Vaccine reimbursed at the nationally established rate

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Nonparticipating Providers

  • Nonparticipating providers can choose not to accept assignment of administration
    • Must submit an unassigned claim on beneficiary’s behalf
    • May collect his/her usual charge for administration but cannot collect any fee upfront for vaccine

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Revised 10/12/2023