Flu Season is Nearly Upon Us… Medical Coding for Influenza Vaccine

Since Flu season is rapidly approaching, we decided to take a look at the medical codes that are utilized for billing of vaccine shots.

First of all, what exactly is the Flu?

Flu is short for Influenza, which is a contagious respiratory disease caused by the Influenza virus. Influenza virus infects the nose, throat, and in a rare condition the lungs. The symptoms can be mild to severe. The most common influenza symptoms include high fever, sore throat, headache, coughing, runny nose, muscle and joint pain, and fatigue (body weakness). This virus generally occurs during the winter months. Influenza is a serious health condition that can lead to pneumonia.

 People infected with the Influenza virus are most likely to have these symptoms two days after exposure to the virus and most last less than a week. However, the cough may last for more than two weeks. Also, in children, there may be vomiting and diarrhea, but these are not usually common in adults. The risks for complication, hospitalization, and death from Flu are higher among people age 65 years and older, young children, and people of any age with underlying health conditions than among healthy older people. Complications of Influenza may include sinus infections, viral pneumonia, secondary bacterial pneumonia, and it can also worsen the previous health condition such as heart failure or asthma. Getting an annual Influenza vaccination is the best way to prevent influenza and its severe complications.

Types of Influenza Virus

There are four types of Influenza viruses namely Type A, Type B, Type C, and Type D. Influenza virus Type D has not been known to infect human, however, they have the potential to do so.

These viruses spread through the air from cough or sneezes. It can also spread by touching surfaces or objects contaminated by the virus and then using the contaminated hands to touch the eyes, mouth, or nose.

The centers for Medicare and Medicaid Services (CMS) has established six separate influenza vaccines Healthcare Common procedure Coding System (HCPCS) codes to differentiate between the brand-names of Influenza vaccines for governmental tracking purposes.  Also, the new Medicare codes help to distinguish between vaccines brands for Medicare, the Healthcare Common Procedure Coding System (HCPCS) code G0008 Administration of Influenza Virus Vaccine should still be used for the administration of the flu vaccine for Medicare patients.

The codes used for a particular vaccine varies depending on the route of administration and age of the patient. The route of administration can be intramuscular or intranasal.

Medicare Codes for Flu Vaccines

The Healthcare Common Procedure Coding System (HCPCS) codes range vaccine Administration G0008 is a standardized code set necessary for Medicare and other health insurance providers to provide healthcare claims. G0008 is used for the Administration of the Influenza virus vaccine.

The New Administered Healthcare Common Procedure Coding System (HCPCS) Medicare Flu vaccine Codes are as follows:

Q2034 – Agriflu Vaccine

Q2035 – Afluria Vaccine

Q2036 – Flulaval Vaccine

Q2037 – Fluvirin Vaccine

Q2038 – Fluzone Vaccine

Q2039 – NOS (Not Otherwise Specified) Vaccine

Q2034 – AGRIFLU VACCINE

Medicare Flu Vaccine Code Q2034. Q2034 is flu vaccine under the brand name Agriflu.  The Influenza vaccine code, split virus. The route of administration is Intramuscular (IM).

Q2035 – AFLURIA VACCINE

Influenza Virus Vaccine, split virus. It is administered to people age 3 years and older. The route of Administration is Intramuscular (IM).

Q2036 – FLULAVAL VACCINE

Influenza Virus Vaccine, split virus. It is administered to people of age 3 years and older. The route of Administration is Intramuscular (IM).

Q2037 – FLUVIRIN VACCINE

Influenza Virus Vaccine, split virus. It is administered to people of age 3 years and older. The route of Administration is Intramuscular (IM).

Q2038 – FLUZONE VACCINE

Influenza Virus Vaccine, split virus. It is administered to people of age 3 years and older. The route of Administration is Intramuscular (IM).

Q2039 – NOS (NOT OTHERWISE SPECIFIED) VACCINE

Influenza Virus Vaccine, split virus. It is administered to people of age 3 years and older. The route of Administration is Intramuscular (IM). (Not Otherwise Specified)

Commercial Insurance Plan Codes for Flu Vaccine

90471 – The Current Procedural Terminology (CPT) code 90471 is a medical procedural code for immunization administration for Vaccines/Toxoids (includes percutaneous, subcutaneous, intradermal, or intramuscular injections).This code is categorized under Administration without counseling.  Code 90471 is used when the drug is administered by a nurse or medical assistant and the patient does not see the physician. This code is also used for patients of age 19 years and older.

90657 – The Current Procedural Terminology (CPT) code 90658 is the Influenza virus vaccine, split virus when administered to individuals 6 – 35 months of age and older. The route of administration is intramuscular (IM).

90658 – The Current Procedural Terminology (CPT) code 90658 is the Influenza virus vaccine, split virus when administered to individuals 3 years of age and older. The route of administration is intramuscular (IM).

As you can see, there are several possible codes for the flu vaccine when you bill Medicare, the code you use is dependent on the manufacturer of the vaccine.

View all Articles by: Melissa Clark, CCS-P