New Medicare Codes ("Q" Codes) for Billing Influenza Vaccinations Effective January 1, 2011
The Centers for Medicare & Medicaid Services (CMS) has created specific HCPCS codes and payment rates for Medicare billing purposes for the 2010-2011 influenza season. Effective for claims with dates of service on or after January 1, 2011, CPT code 90658 (Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use) will no longer be payable by Medicare. Effective for dates of service on or after October 1, 2010, the following new influenza Q codes will be payable by Medicare:
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, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Not otherwise specified)
The administration code is the same “G” code:
G0008 – Administration of influenza virus vaccine
CMS has instructed Medicare contractors to hold all claims containing the influenza Q codes with dates of service on or after October 1, 2010, until their systems are able to accept them for processing. The Medicare contractors’ systems will be ready to process claims containing the Q codes no later than February 7, 2011. Medicare institutional providers also have the option to hold their claims containing the new influenza Q codes until February 7, 2011.
Also, Medicare institutional providers should not submit claims with the new Influenza Q codes with dates of service on or after October 1, 2010, via roster billing. Medicare systems are unable to hold roster claims submitted by institutional providers. Therefore, Medicare institutional providers may submit their roster claims on an individual claim basis or hold their roster claims until February 7, 2011 and then submit as a roster bill at that time.
For further information, please see Transmittal 815, Change Request 7234, issued on November 19, 2010.