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Seasonal Influenza Vaccines Pricing

The Medicare Part B payment allowance limits for seasonal influenza and pneumococcal vaccines are 95% of the Average Wholesale Price (AWP) as reflected in the published compendia except where the vaccine is furnished in a hospital outpatient department.  When the vaccine is furnished in the hospital outpatient department, payment for the vaccine is based on reasonable cost.

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.

To better conform to the Center for Disease Control and Prevention’s (CDC) recommendations for the prevention and control of influenza, CMS is changing the payment limit effective date from September 1 to August 1. Recent CDC recommendations state that vaccination efforts should begin as soon as the seasonal influenza vaccine is available and continue through the influenza season. Please see Transmittal 2424 in the Downloads section for more information.

The payment allowances below reflect the annually updated payment allowance for the listed CPT codes and Q-codes when the vaccines are furnished outside the hospital outpatient department.

Payment Allowances and Effective Dates of for the 2014-2015 Flu Season:

  • CPT 90654 Payment allowance is $18.918. Effective dates: 8/1/2014-7/31/2015
  • CPT 90655 Payment allowance is pending. Effective dates: 8/1/2014-7/31/2015
  • CPT 90656 Payment allowance is $14.096. Effective dates: 8/1/2014-7/31/2015
  • CPT 90657 Payment allowance is $6.022. Effective dates: 8/1/2014-7/31/2015
  • CPT 90661 Payment allowance is $21.666. Effective dates: 8/1/2014-7/31/2015
  • CPT 90662 Payment allowance is $33.374. Effective dates: 8/1/2014-7/31/2015
  • CPT 90672 Payment allowance is $25.736. Effective dates: 8/1/2014-7/31/2015
  • CPT 90673 Payment allowance is $37.193 Effective dates: 9/26/2014-7/31/2015
  • CPT 90685 Payment allowance is $23.900. Effective dates: 8/1/2014-7/31/2015
  • CPT 90686 Payment allowance is $17.984. Effective dates: 8/1/2014-7/31/2015
  • CPT 90687 Payment allowance is $9.134. Effective dates: 8/1/2014-7/31/2015
  • CPT 90688 Payment allowance is $16.844. Effective dates: 8/1/2014-7/31/2015
  • HCPCS Q2035 Payment allowance is $11.885. Effective dates: 8/1/2014-7/31/2015
  • HCPCS Q2036 Payment allowance is $8.579. Effective dates: 8/1/2014-7/31/2015
  • HCPCS Q2037 Payment allowance is $15.396. Effective dates: 8/1/2014-7/31/2015
  • HCPCS Q2038 Payment allowance is $12.044. Effective dates: 8/1/2014-7/31/2015
  • HCPCS Q2039 Flu Vaccine Adult - Not Otherwise Classified payment allowance is to be determined by the local claims processing contractor with effective dates of 8/1/2014-7/31/2015.

Payment Allowances and Effective Dates of for the 2013-2014 Flu Season:

  • CPT 90654 Payment allowance is $18.918. Effective dates: 8/1/2013-7/31/2014
  • CPT 90655 Payment allowance is $17.243. Effective dates: 8/1/2013-7/31/2014
  • CPT 90656 Payment allowance is $12.398. Effective dates: 8/1/2013-7/31/2014
  • CPT 90657 Payment allowance is $6.022. Effective dates: 8/1/2013-7/31/2014
  • CPT 90661 Payment allowance is $20.663. Effective dates: 8/1/2013-7/31/2014
  • CPT 90662 Payment allowance is $31.823. Effective dates: 8/1/2013-7/31/2014
  • CPT 90672 Payment allowance is $24.596. Effective dates: 8/1/2013-7/31/2014
  • CPT 90673 Payment allowance is $36.480. Effective dates: 1/1/2014-7/31/2014
  • CPT 90685 Payment allowance is $23.228. Effective dates: 8/1/2013-7/31/2014
  • CPT 90686 Payment allowance is $19.409. Effective dates: 8/1/2013-7/31/2014
  • CPT 90687 Payment allowance is pending. Effective dates: pending-7/31/2014
  • CPT 90688 Payment allowance is $16.815. Effective dates: pending-7/31/2014
  • HCPCS Q2033 Payment allowance is $36.480. Effective dates: 8/1/2013-12/31/2013
  • HCPCS Q2035 Payment allowance is $11.543. Effective dates: 8/1/2013-7/31/2014
  • HCPCS Q2036 Payment allowance is $8.579. Effective dates: 8/1/2013-7/31/2014
  • HCPCS Q2037 Payment allowance is $14.963. Effective dates: 8/1/2013-7/31/2014
  • HCPCS Q2038 Payment allowance is $12.044. Effective dates: 8/1/2013-7/31/2014
  • HCPCS Q2039 Flu Vaccine Adult - Not Otherwise Classified payment allowance is to be determined by the local claims processing contractor with effective dates of 8/1/2013-7/31/2014.

Additional information on 2013-2014 Influenza Vaccines pricing is available in MM8433, which is available in the 'Downloads' section below. Information for some codes is pending FDA approval. Updates to the payment limits and effective dates will be posted to this webpage.

Payment Allowances Effective for Dates of Service between August 1, 2012 and July 31, 2013:

  • CPT 90655: $16.456
  • CPT 90656: $12.398
  • CPT 90657: $6.023
  • CPT 90660: $23.456
  • CPT 90662: $30.923
  • Q2035 (Afluria): $11.543
  • Q2036 (Flulaval): $9.833
  • Q2037 (Fluvirin): $14.051
  • Q2038 (Fluzone): $12.046
  • Q2034 (Agriflu): locally priced
  • Q2039 (N.O.S.): locally priced

Additional information on 2012-2013 Influenza Vaccines pricing is available in MM8047 which is available in the 'Downloads' section below.

Payment Allowances Effective for Dates of Service between September 1, 2011 and July 31, 2012

  • CPT 90654: $18.383
  • CPT 90655: $15.705
  • CPT 90656: $12.375
  • CPT 90657: $6.653
  • CPT 90660: $22.316
  • CPT 90662: $30.923
  • Q2035 (Afluria): $11.543
  • Q2036 (Flulaval): $8.784
  • Q2037 (Fluvirin): $13.652
  • Q2038 (Fluzone): $13.306
  • Q2039 (N.O.S.): locally priced

Additional information on 2011-2012 Influenza Vaccines pricing is available in MM7575 which is available in the 'Downloads' section below.

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

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

  • CPT 90655: $14.858
  • CPT 90656: $12.375
  • CPT 90657: $6.297
  • CPT 90660: $22.316
  • CPT 90662: $29.213

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

  • CPT 90658: $11.368

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

  • 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 below.

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

  • CPT 90655: $15.447
  • CPT 90656: $12.541
  • CPT 90657: $5.684
  • CPT 90658: $11.368
  • CPT 90660: $22.316

Additional information on 2009 Influenza Vaccines pricing is available in MM6608 which is available in the 'Downloads' section below.

Payment Allowances Effective for Dates of Service between September 1, 2008 and August 31, 2009

  • CPT 90655: $16.879
  • CPT 90656: $18.198
  • CPT 90657: $6.609
  • CPT 90658: $13.218
  • CPT 90660: $22.316

Additional information on 2008 Influenza and Pneumococcal Vaccines pricing is available in MM6153, which is available in the 'Downloads' section below.

Payment Allowances Effective for Dates of Service between September 1, 2007 and August 31, 2008

  • CPT 90655: $16.109
  • CPT 90656: $17.366
  • CPT 90657: $6.609
  • CPT 90658: $13.218
  • CPT 90660: $21.176

Additional information on 2007 Influenza and Pneumococcal Vaccines pricing is available in MM5744 and MM5910, which are available in the 'Downloads' section below.

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