Flu Shot

• Get payment allowances & effective dates for the 2022-2023 season
• Patients 65 and older should get a preferred vaccine if available. Preferred vaccines are potentially more effective than standard dose flu vaccines. There are 3 recommended vaccines:
  1. Fluzone High-Dose Quadrivalent vaccine
  2. Flublok Quadrivalent recombinant flu vaccine
  3. Fluad Quadrivalent adjuvanted flu vaccine
• If one of these recommended vaccines isn’t available, give your patients a standard-dose flu vaccine instead.
• Learn about expanded skilled nursing facility enforcement discretion for certain pharmacy billing effective September 20, 2021.

Frequency & Coverage

• The CDC recommends annual flu shots for everyone 6 months and older by the end of October or as soon as possible each flu season.
• Medicare Part B covers the seasonal flu shot.
• We cover additional flu shots if medically necessary. Patients can get flu shots twice in a calendar year during 2 different flu seasons, and we’ll pay for both shots.
• Your patients pay nothing if you accept assignment. There’s no copayment, coinsurance, or deductible.
• You can now check eligibility (PDF) for the flu shot. We give information from claims billed in the last 18 months:
  • CPT or HCPCS codes
  • Dates of service
  • NPIs who administered the shots

  If you need help, contact your eligibility service provider.

Billing

• All providers who administer the flu shot must accept assignment.
• You may use roster billing or submit an individual claim. Learn more about roster billing, mass immunizers, and centralized billing.
• Entities, like local health facilities, must get an NPI (PDF) if they’ve never submitted Medicare claims.

ICD-10, HCPCS, and CPT codes

ICD-10 Code: Z23

HCPCS & CPT Codes

Administration & Diagnosis Codes	Vaccine Codes & Descriptors
90630	Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, for intradermal use
90653	Influenza vaccine, inactivated (IIV), subunit, adjuvanted, for intramuscular use
90654	Influenza virus vaccine, trivalent (IIV3), split virus, preservative-free, for intradermal use
90655	Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, 0.25 mL dosage, for intramuscular use
90656	Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, 0.5 mL dosage, for intramuscular use
90657	Influenza virus vaccine, trivalent (IIV3), split virus, 0.25 mL dosage, for intramuscular use
90658	Influenza virus vaccine, trivalent (IIV3), split virus, 0.5 mL dosage, for intramuscular use
90660	Influenza virus vaccine, trivalent, live (LAIV3), for intranasal use
90662	Influenza virus vaccine (IIV), split virus, preservative free, enhanced immunogenicity via increased antigen content, for intramuscular use
90672	Influenza virus vaccine, quadrivalent, live (LAIV4), for intranasal use
90673	Influenza virus vaccine, trivalent (RIV3), derived from recombinant DNA, hemagglutinin (HA) protein only, preservative and antibiotic free, for intramuscular use
90674	Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage, for intramuscular use
90682	Influenza virus vaccine, quadrivalent (RIV4), derived from recombinant DNA, hemagglutinin (HA) protein only, preservative and antibiotic free, for intramuscular use
90685	Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, 0.25 mL dosage, for intramuscular use
90686	Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, 0.5 mL dosage, for intramuscular use
90687	Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.25 mL dosage, for intramuscular use
90688	Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.5 mL dosage, for intramuscular use
90689	Influenza virus vaccine quadrivalent (IIV4), inactivated, adjuvanted, preservative free, 0.25mL dosage, for intramuscular use
90694	Influenza virus vaccine, quadrivalent (aIIV4), inactivated, adjuvanted, preservative free, 0.5 mL dosage, for intramuscular use
90756	Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, antibiotic free, 0.5 mL dosage, for intramuscular use
Q2034	Influenza virus vaccine, split virus, for intramuscular use (agriflu)
Q2035	Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (afluria)
Q2036	Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (flulaval)
Q2037	Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (fluvirin)
Q2038	Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (fluzone)
Q2039	Influenza virus vaccine, not otherwise specified
G0008	Administration of influenza virus vaccine

Additional Resources

• Preventive Services: Flu educational tool
• CDC Flu webpage
• Section 50.4.4.2 Medicare Benefit Policy Manual, Chapter 15 - Covered Medical and Other Health Services (PDF)
• Section 10 Medicare Claims Processing Manual, Chapter 18 - Preventive and Screening Services (PDF)