2017-2018 Influenza (Flu) Resources for Health Care Professionals

January 4th, 2018 - Find-A-Code

Categories: CPT^® Coding HCPCS Coding

Per CMS: Medicare provides coverage of the flu vaccine without any out-of-pocket costs to the Medicare patient. No deductible or copayment/coinsurance applies. Annual Part B deductible and coinsurance amounts do not apply.

Payment allowance limits for personal flu and pneumococcal vaccines are 95 percent of the Average Wholesale Price (AWP), except where the vaccine is furnished in a hospital outpatient department, Rural Health Clinic (RHC), or Federally Qualified Health Center (FQHC). In these cases, the payment for the vaccine is based on reasonable cost.

CPT 90630 $20.343 8/1/2017-7/31/2018

CPT 90653 $50.217 8/1/2017-7/31/2018

CPT 90654 Pending 8/1/2017-7/31/2018

CPT 90655 Pending 8/1/2017-7/31/2018

CPT 90656 $19.247 8/1/2017-7/31/2018

CPT 90657 Pending 8/1/2017-7/31/2018

CPT 90661 Pending 8/1/2017-7/31/2018

CPT 90662 $49.025 8/1/2017-7/31/2018

CPT 90672 Pending 8/1/2017-7/31/2018

CPT 90673 $40.613 8/1/2017-7/31/2018

CPT 90674 $24.047 8/1/2017-7/31/2018

CPT 90682 $46.313 8/1/2017-7/31/2018 (New code)

CPT 90685 $21.198 8/1/2017-7/31/2018

CPT 90686 $19.032 8/1/2017-7/31/2018

CPT 90687 $9.403 8/1/2017-7/31/2018

CPT 90688 $17.835 8/1/2017-7/31/2018

CPT 90756* $22.793 1/1/2018-7/31/2018

HCPCS Q2039** ** See Note below ** 8/1/2017-7/31/2018

HCPCS Q2035 $17.685 8/1/2017-7/31/2018

HCPCS Q2036 Pending 8/1/2017-7/31/2018 HCPCS Q2037 $17.685 8/1/2017-7/31/2018

HCPCS Q2038 Pending 8/1/2017-7/31/2018

*Until CPT code 90756 is implemented on 1/1/2018, Q2039 will be used for products described by the following language: influenza virus vaccine, quadrivalent (ccllV4), derived from cell cultures, subunit, antibiotic free, 0.5mL dosage, for intramuscular use. The payment allowance for these products, effective for dates of service from 8/1/2017 to 12/31/2017, is $22.793. **Providers and MACs will use HCPCS Q2039 for dates of service from 8/1/2017- 12/31/2017. HCPCS Q2039 Flu Vaccine Adult – Not Otherwise Classified.

The payment allowance will be determined by the local claims processing contractor with effective dates of 8/1/2017-7/31/2018. Providers are encouraged to review MLN Matters Article MM10224. If you have any questions, please contact your MAC at their toll-free number. That number is available at https://www.cms.gov/Research-Statistics-Data-and-Systems/MonitoringPrograms/Medicare-FFS-Compliance-Programs/Review-Contractor-Directory-Interactive-Map/.

###

Questions, comments?

If you have questions or comments about this article please contact us. Comments that provide additional related information may be added here by our Editors.

Latest articles: (any category)

Artificial Intelligence in Healthcare - A Medical Coder's Perspective
December 26th, 2023 - Aimee Wilcox

We constantly hear how AI is creeping into every aspect of healthcare but what does that mean for medical coders and how can we better understand the language used in the codeset? Will AI take my place or will I learn with it and become an integral part of the process that uses AI to enhance my abilities?

Specialization: Your Advantage as a Medical Coding Contractor
December 22nd, 2023 - Find-A-Code

Medical coding contractors offer a valuable service to healthcare providers who would rather outsource coding and billing rather than handling things in-house. Some contractors are better than others, but there is one thing they all have in common: the need to present some sort of value proposition in order to land new clients. As a contractor, your value proposition is the advantage you offer. And that advantage is specialization.

ICD-10-CM Coding of Chronic Obstructive Pulmonary Disease (COPD)
December 19th, 2023 - Aimee Wilcox

Chronic respiratory disease is on the top 10 chronic disease list published by the National Institutes of Health (NIH). Although it is a chronic condition, it may be stable for some time and then suddenly become exacerbated and even impacted by another acute respiratory illness, such as bronchitis, RSV, or COVID-19. Understanding the nuances associated with the condition and how to properly assign ICD-10-CM codes is beneficial.

Changes to COVID-19 Vaccines Strike Again
December 12th, 2023 - Aimee Wilcox

According to the FDA, CDC, and other alphabet soup entities, the old COVID-19 vaccines are no longer able to treat the variants experienced today so new vaccines have been given the emergency use authorization to take the place of the old vaccines. No sooner was the updated 2024 CPT codebook published when 50 of the codes in it were deleted, some of which were being newly added for 2024.

Updated ICD-10-CM Codes for Appendicitis
November 14th, 2023 - Aimee Wilcox

With approximately 250,000 cases of acute appendicitis diagnosed annually in the United States, coding updates were made to ensure high-specificity coding could be achieved when reporting these diagnoses. While appendicitis almost equally affects both men and women, the type of appendicitis varies, as dose the risk of infection, sepsis, and perforation.

COVID Vaccine Coding Changes as of November 1, 2023
October 26th, 2023 - Wyn Staheli

COVID vaccine changes due to the end of the PHE as of November 1, 2023 are addressed in this article.

Medicare Guidance Changes for E/M Services
October 11th, 2023 - Wyn Staheli

2023 brought quite a few changes to Evaluation and management (E/M) services. The significant revisions as noted in the CPT codebook were welcome changes to bring other E/M services more in line with the changes that took place with Office or Other Outpatient Services a few years ago. As part of CMS’ Medicare Learning Network, the “Evaluation and Management Services Guide” publication was finally updated as of August 2023 to include the changes that took place in 2023. If you take a look at the new publication (see references below),....