CMS releases updates to billing for flu vaccine

by The Bottom Line

Flu season is August to April. Make sure you’re prepared to start billing for the influenza virus vaccine by staying up to date on the latest code and payment allowance updates. So far, CMS has released the following two notices:

1. Payment allowances for the influenza virus vaccine are updated on August 1 each year. This year’s annual update has been released, according to a CMS MLN Matters article. Click here for 2018-2019 payment allowances and effective dates.

2. Quarterly influenza virus vaccine code update, effective January 1, 2019. This update includes one new influenza virus vaccine code: 90689. MACs will pay for influenza virus vaccine code 90689 with a Type of Service (TOS) of V based on reasonable cost to:

  • Hospitals (Type of Bill 12X and 13X)
  • Skilled Nursing Facilities (22X and 23X)
  • Home Health Agencies (34X)
  • Hospital-based renal dialysis facilities (72X)
  • Critical Access Hospitals (85X)

MACs will pay for influenza virus vaccine code 90689 with a TOS of V based on the lower of the actual charge or 95 percent of the Average Wholesale Price (AWP), to:

  • Indian Service Hospitals (IHS) (12X and 13X)
  • Hospices (81X and 82X)
  • IHS Critical Access Hospitals (85X)
  • Comprehensive Outpatient Rehabilitation Facilities (CORFs) (75X)
  • Independent Renal Dialysis Facilities (72X)

Note: In all cases, coinsurance and deductible do not apply.

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