Flu Season is Here - Are YOU Ready?

Flu Season is Here - Are YOU Ready?

To have a successful flu season with the highest level of reimbursement, there are a few steps that you should take.

The new flu injection CPT codes and payment allowable goes into effect each year on Aug. 1 for Medicare and most governmental payors. This allows vaccination efforts to begin as soon as the seasonal influenza vaccines are available. Just like any other injection, you will need to know the following NDC information to determine the correct CPT Vaccine Code to submit on your claim.

  • What brand will you be using for this season.
  • Whether the product was trivalent or quadrivalent.
    • Trivalent – Protects against three different flu viruses. Two A viruses and one B virus. Considered High Dose Vaccine.
    • Quadrivalent – Protects against four different flu viruses.  Two A viruses and two B viruses. Considered Standard Vaccine.
  • Medicare Guidelines: Administration Code for Flu injection is G0008 – Administration of influenza virus vaccine.
  • Commercial Guidelines: Administration Code for Flu is 90471 -Immunization Administration for Vaccines/Toxoids.
  • Whether the product was preservative-free.

Once you have determined your correct CPT code for the season, you are ready to go. Just remember that you should report two CPT codes, one for the vaccine and one for the administration. When coding the administration service, be sure that you confirm your primary insurance guidelines for that claim as some payors may not cover an administration fee. 

Once the correct administration code has been determined, make sure the appropriate ICD-10 diagnosis code is being used. If the sole purpose of the encounter is to administer a vaccine, only use Z23 on the vaccine code and the administration code.

When a physician administers the flu shot during an examination for 99201-99205 and 99211-99215, use a 25 modifier on the E/M code if insurance guidelines allow for it.

Allow your EMR to work for you. Some EMR systems have the capacity to create rules and/or alternative configurations to assist with insurance guidelines. If your tool can do it, configure it to auto-assign ICD-10 code Z23 for the flu vaccine and administration codes.