Reimbursement and Coding

The following provides a comprehensive overview of coding, coverage, and reimbursement information for administration of
Fluvirin in your practice.

Reimbursement assistance is also available by phone. Contact us at 877-NV-DIRECT (877-683-4732).

 

Payment Allowances Effective for Dates of Service between September 1, 2011 and August 31, 2012 as specified below

CPT Code Amount
90654 $18.383
90655 $15.705
90656 $12.375
90657 $6.653
90660 $22.316
90662 $30.923
   
Q2035 (Afluria) $11.543
Q2036 (Flulaval) locally priced
Q2037 (Fluvirin) $13.652
Q2038 (Fluzone) $13.306
Q2039 (N.O.S.) locally priced

A link to an MLN Matters article with additional information will be posted when it becomes available.
 

Payment Allowances Effective for Dates of Service between September 1, 2010 and August 31, 2011 as specified below

Dates of Service between September 1, 2010 and August 31, 2011

CPT Code Amount
90655 $14.858
90656 $12.375
90657 $6.297
90660 $22.316
90662 $29.213
 

Dates of Service between September 1, 2010 and December 31, 2010

CPT Code Amount
90658 $11.368
 

Dates of Service between October 1, 2010 and August 31, 2011

CPT Code Amount
Q2035 (Afluria) locally priced
Q2036 (Flulaval) $8.784
Q2037 (Fluvirin) $13.253
Q2038 (Fluzone) $12.593
Q2039 (N.O.S.) locally priced

Additional information on 2010 Influenza Vaccines pricing is available in MM7120 and MM7234 which are available in the 'Downloads' section on the Centers for Medicare & Medicaid Services website.
 

Payment Allowances Effective for Dates of Service between September 1, 2009 and August 31, 2010  

CPT Code Amount
90655 $15.447
90656 $12.541
90657 $5.684
90658 $11.368
90660 $22.316
 

Vaccine Code
The billing codes and descriptions for Fluvirin are provided below.Print Codes

HCPCS Code Short Description Code Description
Q2037 Fluvirin vacc. 4 yrs & >, im Influenza virus vaccine, split virus, when administered to individuals 4 years of age and older, for intramuscular use
 
Please Note: Actual reimbursement rates are calculated based on a percentage of the final product price. For more information please click here.

Administration Codes
The administration codes for Fluvirin are provided below.

Administration Code Code Description
90658 Influenza virus vaccine, split virus, for use in individuals 3 years of age and above, for intramuscular use. (Note: These are the codes applicable for Fluvirin billing.)
90471 Immunization administration; one vaccine (If Fluvirin vaccine is the first vaccine administered), but please note that Fluvirin is indicated for use in persons 4 years of age and older.
90472* Immunization administration; each additional vaccine (If Fluvirin vaccine is the second or subsequent vaccine administered)
90465 Immunization administration younger than 8 years when the physician counsels the patient/family; first injection, per day
90466* Each additional injection, per day (List separately in addition to code for primary procedure)
*Add-on code that must be used with primary administration code.

 

For additional information on Medicare adult immunizations please visit: www.cms.hhs.gov/AdultImmunizations/

ICD-9 Codes
The ICD-9 codes for influenza are as follows:

ICD-9 Code Diagnosis
V04.81 Need for prophylactic vaccination and inoculation against certain viral diseases, other viral disease, influenza
V06.6 Need for prophylactic vaccination and inoculation against combination of diseases, streptococcus pneumoniae and influenza when influenza and pneumococcal vaccine are provided on the same day

Additional Medicare coding for Fluvirin:
G0008 Administration of influenza virus vaccine
 
For additional information, visit: www.cms.hhs.gov
 

Indication and Important Safety Information

Fluvirin vaccine is an inactivated influenza virus vaccine indicated for active immunization of persons 4 years of age and older against influenza disease caused by influenza virus subtypes A and type B contained in the vaccine.

Fluvirin vaccine is not indicated for children less than 4 years of age because there is evidence of diminished immune response in this age group.

Serious allergic reactions, including anaphylactic shock, have been observed in people receiving FLUVIRIN Influenza Virus Vaccine. FLUVIRIN vaccine should not be administered to individuals with a history of systemic hypersensitivity reaction to eggs or egg proteins or other components of FLUVIRIN vaccine, including thimerosal, or to anyone who has had a life-threatening reaction to previous influenza vaccination.

Pre-filled syringes of 2010/2011 FLUVIRIN influenza vaccine are tipped with caps which may contain natural rubber latex in trace amounts. Do not administer pre-filled syringe doses of FLUVIRIN vaccine to any patients with a demonstrated history of hypersensitivity to latex. Multi-dose vial presentations of FLUVIRIN are latex-free.

In clinical trials, the most common adverse events in adults were headache, fatigue, injection site reactions (pain, mass, redness, and induration), and malaise. These adverse events were generally mild/moderate and transient. Vaccination with FLUVIRIN vaccine may not protect all individuals who are susceptible to influenza.

Immunocompromised persons, including individuals receiving immunosuppressive therapy, may have a reduced immune response to FLUVIRIN vaccine. If Guillain-Barré syndrome has occurred within 6 weeks of receipt of prior influenza vaccine, the decision to use FLUVIRIN vaccine should be based on careful consideration of the potential benefits and risks. All people, including those who are pregnant, nursing, and/or taking other medications, should consult their healthcare providers before receiving FLUVIRIN vaccine.