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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.

In 2012, to better conform to the Center for Disease Control and Prevention’s (CDC) recommendations for the prevention and control of influenza, CMS changed 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 R2424CP .

Payment Allowances and Effective Dates for the 2018-2019 Flu Season:

Code Labeler Name Drug Name Payment Allowance Effective Dates
90653 Seqirus Inc Fluad (2018/2019) $54.673 08/01/2018 - 07/31/2019
90656 Seqirus Inc Afluria (2018/2019) $19.773 08/01/2018 - 07/31/2019
90662 Sanofi Pasteur Fluzone High-Dose (2018/2019) $53.373 08/01/2018 - 07/31/2019
90674 Seqirus Inc Flucelvax Quadrivalent (2018/2019) $24.047 08/01/2018 - 07/31/2019
90682 Sanofi Pasteur Flublok Quadrivalent (2018/2019) $53.373 08/01/2018 - 07/31/2019
90685 Sanofi Pasteur Fluzone Quadrivalent Pediatric (2018/2019) $21.813 08/01/2018 - 07/31/2019
90686 Seqirus Inc, GlaxoSmithKline,
Sanofi Pasteur
Afluria Quadrivalent (2018/2019), Fluarix Quadrivalent (2018/2019), Flulaval Quadrivalent (2018/2019), Fluzone Quadrivalent (2018/2019) [Preservative Free] $19.032 08/01/2018 - 07/31/2019
90687 Sanofi Pasteur Fluzone Quadrivalent Pediatric (2018/2019) $9.403 08/01/2018 - 07/31/2019
90688 Seqirus Inc, GlaxoSmithKline,
Sanofi Pasteur
Afluria Quadrivalent (2018/2019), Flulaval Quadrivalent (2018/2019), Fluzone Quadrivalent (2018/2019) $17.835 08/01/2018 - 07/31/2019
90756 Seqirus Inc Flucelvax Quadrivalent (2018/2019) $22.793 08/01/2018 - 07/31/2019
Q2035 Seqirus Inc Afluria (2018/2019) $18.236 08/01/2018 - 07/31/2019

Additional information on 2018-2019 Influenza Vaccines pricing is available in MM10914 [PDF, 185KB]  Information for some codes is pending FDA approval. Updates to the payment limits and effective dates will be posted to this webpage.

Payment Allowances and Effective Dates for the 2017-2018 Flu Season:

  • CPT 90630 Payment allowance is $20.343. Effective dates: 8/1/2017-7/31/2018
  • CPT 90653 Payment allowance is $50.217. Effective dates: 8/1/2017-7/31/2018
  • CPT 90656 Payment allowance is $19.247. Effective dates: 8/1/2017-7/31/2018
  • CPT 90662 Payment allowance is $49.025. Effective dates: 8/1/2017-7/31/2018
  • CPT 90673 Payment allowance is $40.613. Effective dates: 8/1/2017-7/31/2018
  • CPT 90674 Payment allowance is $24.047. Effective dates: 8/1/2017-7/31/2018
  • CPT 90682 Payment allowance is $46.313. Effective dates: 8/1/2017-7/31/2018 (New code)
  • CPT 90685 Payment allowance is $21.198. Effective dates: 8/1/2017-7/31/2018
  • CPT 90686 Payment allowance is $19.032. Effective dates: 8/1/2017-7/31/2018
  • CPT 90687 Payment allowance is $9.403. Effective dates: 8/1/2017-7/31/2018
  • CPT 90688 Payment allowance is $17.835. Effective dates: 8/1/2017-7/31/2018
  • CPT 90756 Payment allowance is $22.793. Effective dates: 1/1/2018-7/31/2018  (Note: Providers and Medicare Administrative Contractors shall use HCPCS Q2039 for dates of service from 8/1/2017 – 12/31/2017. See special note under HCPCS Q2039 for payment amounts for this product prior to 1/1/2018.)
  • HCPCS Q2035 Payment allowance is $17.685. Effective dates: 8/1/2017-7/31/2018
  • HCPCS Q2037 Payment allowance is $17.685. Effective dates: 8/1/2017-7/31/2018
  • HCPCS Q2039 Flu Vaccine Adult - Not Otherwise Classified payment allowance is to be determined by the local claims processing contractor with effective dates of 8/1/2017-7/31/2018.

Additional information on 2017-2018 Influenza Vaccines pricing is available in MM10224 [PDF, 289KB] . Information for some codes is pending FDA approval. Updates to the payment limits and effective dates will be posted to this webpage.

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