Seasonal Influenza Vaccines Pricing

The Medicare Part B payment allowance limits for seasonal influenza (flu) vaccines are 95% of the Average Wholesale Price (AWP), as reflected in the published compendia.

In hospital outpatient departments, payment is based on reasonable cost.

Annual Part B deductible and coinsurance amounts don’t apply for the influenza virus vaccinations. All physicians, non-physician practitioners, and suppliers who administer these vaccinations must take assignment on the claim for the vaccine.

Annual Influenza Vaccine season starts on August 1 and ends on July 31 of the following year.
 

Payment Allowances and Effective Dates by Flu Season

2021 - 2022

Payment Allowances and Effective Dates for the 2021-2022 Flu Season:

Code

Labeler Name

Vaccine Name

Payment Allowance

Effective Dates

90662

Sanofi Pasteur

Fluzone High-Dose Quadrivalent (2021/2022)

 $65.261

08/01/2021 – 07/31/2022

90672

MedImmune

FluMist Quadrivalent (2021/2022)

 $26.876

08/26/2021 – 07/31/2022

90674

Seqirus

Flucelvax Quadrivalent (2021/2022) (Pres Free)

 $29.940

08/11/2021 – 07/31/2022

90682

Sanofi Pasteur

Flublok Quadrivalent (2021/2022)

 $65.261

 

08/01/2021 – 07/31/2022

90685

Sanofi Pasteur

Seqirus

Fluzone Quadrivalent 0.25ml  (2021/2022) (Pres Free)

Afluria Quadrivalent 0.25ml (2021/2022) (Pres Free)

 $21.639

08/01/2021 – 07/31/2022

90686

GlaxoSmithKline

Sanofi Pasteur

Seqirus

Fluarix Quadrivalent (2021/2022) (Pres free)

Flulaval Quadrivalent (2021/2022) (Pres Free)

Fluzone Quadrivalent  (2021/2022) (Pres Free)

Afluria Quadrivalent (2021/2022) (Pres Free)

 $20.526

08/01/2021 – 07/31/2022

90687

Sanofi Pasteur

Seqirus

Fluzone Quadrivalent  0.25ml (2021/2022)

Afluria Quadrivalent 0.25ml (2021/2022)

 $9.953

08/01/2021 – 07/31/2022

90688

Sanofi Pasteur

Seqirus

Fluzone Quadrivalent (2021/2022)

Afluria Quadrivalent (2021/2022)

 $19.906

08/01/2021 – 07/31/2022

90694

Seqirus

Fluad Quadrivalent (2021/2022)

 $66.426

08/11/2021 – 07/31/2022

90756

Seqirus

Flucelvax Quadrivalent (2021/2022)

 $28.370

08/11/2021 – 07/31/2022


Payment limits and effective dates for newly approved and marketed influenza vaccines will be posted to this webpage.
 

2020 - 2021

Payment Allowances and Effective Dates for the 2020-2021 Flu Season:

Code

Labeler Name

Vaccine Name

Payment Allowance

Effective Dates

90653

Seqirus

Fluad (2020/2021)

 $59.529

8/01/2020 – 07/31/2021

90694

Seqirus

Fluad Quadrivalent (2020/2021)

 $61.000

8/01/2020 – 07/31/2021

90662

Sanofi Pasteur

Fluzone High-Dose Quadrivalent (2020/2021)

 $ 60.982

8/05/2020 – 07/31/2021

90672

MedImmune

FluMist Quadrivalent (2020/2021)

 $26.876

8/12/2020 – 07/31/2021

90674

Seqirus

Flucelvax Quadrivalent (2020/2021) (Pres Free)

 $29.228

8/06/2020 – 07/31/2021

90682

Sanofi Pasteur

Flublok Quadrivalent (2020/2021)

 $60.982

 

8/01/2020 – 07/31/2021

90685

Sanofi Pasteur

Seqirus

Fluzone Quadrivalent 0.25ml  (2020/2021) (Pres Free)

Afluria Quadrivalent 0.25ml (2020/2021) (Pres Free)

 $21.129

8/01/2020 – 07/31/2021

90686

GlaxoSmithKline

Sanofi Pasteur

Seqirus

Fluarix Quadrivalent (2020/2021) (Pres free)

Flulaval Quadrivalent (2020/2021) (Pres Free)

Fluzone Quadrivalent  (2020/2021) (Pres Free)

Afluria Quadrivalent (2020/2021) (Pres Free)

 $19.581

08/01/2020 – 07/31/2021

90687

Sanofi Pasteur

Seqirus

Fluzone Quadrivalent  0.25ml (2020/2021)

Afluria Quadrivalent 0.25ml (2020/2021)

 $9.584

8/01/2020 – 07/31/2021

90688

Sanofi Pasteur

Seqirus

Fluzone Quadrivalent (2020/2021)

Afluria Quadrivalent (2020/2021)

 $19.168

8/01/2020 – 07/31/2021

90756

Seqirus

Flucelvax Quadrivalent (2020/2021)

 $27.695

8/06/2020 – 07/31/2021

Payment limits and effective dates for newly approved and marketed influenza vaccines will be posted to this webpage.

2019 - 2020

Payment Allowances and Effective Dates for the 2019-2020 Flu Season:​ ​

Code Labeler Name Drug Name Payment Allowance Effective Dates
90653 Seqirus Fluad (2019/2020) $59.530 08/01/2019 - 07/31/2020
90662 Sanofi Pasteur Fluzone High-Dose (2019/2020)  
$56.006
08/01/2019 - 07/31/2020
90672 MedImmune FluMist Quadrivalent (2019/2020) $26.876 08/01/2019 - 07/31/2020
90674 Seqirus Flucelvax Quadrivalent (2019/2020) (Pres Free) $28.130 08/01/2019 - 07/31/2020
90682 Sanofi Pasteur Flublok Quadrivalent (2019/2020)  $56.006 08/01/2019 - 07/31/2020
90685

Sanofi Pasteur

Seqirus

Fluzone Quadrivalent 0.25ml  (2019/2020) (Pres Free)
Afluria Quadrivalent 0.25ml (2019/2020) (Pres Free)

 $20.343 08/01/2019 - 07/31/2020
90686

GlaxoSmithKline

Sanofi Pasteur

Seqirus

Fluarix Quadrivalent (2019/2020) (Pres free)
Flulaval Quadrivalent (2019/2020) (Pres Free)
Fluzone Quadrivalent  (2019/2020) (Pres Free)
Afluria Quadrivalent (2019/2020) (Pres Free)

 $19.032 08/01/2019 - 07/31/2020
90687

Sanofi Pasteur

Seqirus

Fluzone Quadrivalent  0.25ml (2019/2020)
Afluria Quadrivalent 0.25ml (2019/2020)

 $9.403 08/01/2019 - 07/31/2020
90688

GlaxoSmithKline

Sanofi Pasteur

Seqirus

Flulaval Quadrivalent (2019/2020)Fluzone Quadrivalent (2019/2020)
Afluria Quadrivalent (2019/2020)

$17.835 08/01/2019 - 07/31/2020
90756 Seqirus Flucelvax Quadrivalent (2019/2020) $26.657 08/01/2019 - 07/31/2020

If any new vaccine received FDA approval after the initial publication, the payment limits and effective dates will be posted to this webpage.

CY 2021 Vaccine Administration Locality-Adjusted Payment Rates for Physicians and Mass Immunizers

  1. Get your locality and Medicare Administrative Contractor numbers (PDF) based on your practice location
  2. Using your locality number, get your locality-adjusted payment rate (ZIP) under G0008, Column K (Total Pay)

During the flu season, if the FDA approves new vaccines, we’ll update our pricing table.


Get more information on frequency & coverage, coding, and billing. 
 

Page Last Modified:
09/15/2021 12:37 PM