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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 2016-2017 Flu Season:

  • CPT 90630 Payment allowance is $20.343. Effective dates: 8/1/2016-7/31/2017
  • CPT 90653 Payment allowance is $37.383. Effective dates: 8/1/2016-7/31/2017
  • CPT 90656 Payment allowance is $17.717. Effective dates: 8/1/2016-7/31/2017
  • CPT 90657 Payment allowance is pending. Effective dates: 8/1/2016-7/31/2017
  • CPT 90661 Payment allowance is pending. Effective dates: 8/1/2016-7/31/2017
  • CPT 90662 Payment allowance is $42.722. Effective dates: 8/1/2016-7/31/2017
  • CPT 90672 Payment allowance is $26.876. Effective dates: 8/1/2016-7/31/2017
  • CPT 90673 Payment allowance is $40.613 Effective dates: 8/1/2016-7/31/2017
  • CPT 90674 Payment allowance is $22.936 Effective dates: 8/1/2016-7/31/2017 (Claims for this code must be held until 1/1/2017)
  • CPT 90685 Payment allowance is $26.268. Effective dates: 8/1/2016-7/31/2017
  • CPT 90686 Payment allowance is $19.032. Effective dates: 8/1/2016-7/31/2017
  • CPT 90687 Payment allowance is $9.403. Effective dates: 8/1/2016-7/31/2017
  • CPT 90688 Payment allowance is $17.835. Effective dates: 8/1/2016-7/31/2017
  • HCPCS Q2035 Payment allowance is $16.284. Effective dates: 8/1/2016-7/31/2017
  • HCPCS Q2037 Payment allowance is $16.284. Effective dates: 8/1/2016-7/31/2017
  • HCPCS Q2039 Flu Vaccine Adult - Not Otherwise Classified payment allowance is to be determined by the local claims processing contractor with effective dates of 8/1/2016-7/31/2017.

Additional information on 2016-2017 Influenza Vaccines pricing is available in MM9758 [PDF, 54KB] . 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 2015-2016 Flu Season:

  • CPT 90630 Payment allowance is $23.467. Effective dates: 8/1/2015-7/31/2016
  • CPT 90654 Payment allowance is pending. Effective dates: 8/1/2015-7/31/2016
  • CPT 90655 Payment allowance is pending. Effective dates: 8/1/2015-7/31/2016
  • CPT 90656 Payment allowance is $13.880. Effective dates: 8/1/2015-7/31/2016
  • CPT 90657 Payment allowance is $6.022. Effective dates: 8/1/2015-7/31/2016
  • CPT 90661 Payment allowance is $22.288. Effective dates: 8/1/2015-7/31/2016
  • CPT 90662 Payment allowance is $36.315. Effective dates: 8/1/2015-7/31/2016
  • CPT 90672 Payment allowance is $26.876. Effective dates: 8/1/2015-7/31/2016
  • CPT 90673 Payment allowance is $37.193 Effective dates: 8/1/2015-7/31/2016
  • CPT 90685 Payment allowance is $24.596. Effective dates: 8/1/2015-7/31/2016
  • CPT 90686 Payment allowance is $18.155. Effective dates: 8/1/2015-7/31/2016
  • CPT 90687 Payment allowance is $9.134. Effective dates: 8/1/2015-7/31/2016
  • CPT 90688 Payment allowance is $18.269. Effective dates: 8/1/2015-7/31/2016
  • HCPCS Q2035 Payment allowance is $13.025. Effective dates: 8/1/2015-7/31/2016
  • HCPCS Q2036 Payment allowance is pending. Effective dates: 8/1/2015-7/31/2016
  • HCPCS Q2037 Payment allowance is $15.830. Effective dates: 8/1/2015-7/31/2016
  • HCPCS Q2038 Payment allowance is $12.044. Effective dates: 8/1/2015-7/31/2016
  • HCPCS Q2039 Flu Vaccine Adult - Not Otherwise Classified payment allowance is to be determined by the local claims processing contractor with effective dates of 8/1/2015-7/31/2016.

Additional information on 2015-2016 Influenza Vaccines pricing is available in MM9299 [PDF, 78KB]  . 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 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.