Flu shots are paid by season and not by the year.
Falling sick can be troublesome, and it can be even more so for Medicare providers and their staff to report influenza vaccinations. The 2017-2018 flu season started on Aug. 1 and will continue through July 31, 2018. If, like most offices at this time of year, you’re ramping up your vaccinations for the flu season, here’s an update you to keep in mind to avoid flu aches and denials in the new year.
Add Two Codes to Your Vaccine Coding List
Effective Jan. 1, 2018, you’ll have two additional flu-vaccine codes to choose from: 90682 and 90756. This change is a continuation of last year’s update that focused CPT® descriptors on dosage while discontinuing age specificity.
Background: Although you’ll use these new codes starting Jan. 1, technically, CPT® has already released 90756 on July 1, 2017, and some payers are already accepting the vaccine (known by its trademark name Flucelvax). The code has a payment allowance of $46.313. However, if your payer is not accepting this code, you can report 90749 (Unlisted vaccine/toxoid) or HCPCS code Q2039 for Medicaid patients.
Similarly, the code 90682 surfaced on the AMA website on July 1, 2016 and became effective Jan. 1, 2017. It’s only in 2018, though, that you will find this code in the CPT® code book. This code will have a payment allowance of $22.793.
Don’t Forget This Shingles Vaccine Code
You will also be able to document 90750 after Jan. 1 if your provider administers this vaccination to help prevent an occurrence/ reoccurrence of shingles in patients over the age of sixty. FDA approval of this vaccine is still pending, as per CPT®.
Hang on to Your Immunization Income
According to CMS guidance, flu shots are paid by season and not by the year, so it is likely that a patient could receive more than one vaccination in a calendar year. Recently, Medicare has updated its price for flu vaccination with guidance on who is covered and how much Part B will reimburse for each CPT®/HCPCS code.
Remember that Medicare Part B beneficiaries have no out-of-pocket costs for flu vaccines, as deductibles or copayments aren’t applicable.
Is Your Vaccine Coding Up-to-Speed?
Proper reporting of influenza vaccines and administration can safeguard your practice against revenue loss related to providing immunizations. But how do you keep up with the changing procedure codes and varying payer rules?
Learn more about these new vaccine code additions and get all the info you need to properly report 2018 CPT® codes for your practice by relying on TCI’s one-stop procedure coding solutions.
Check out an extensive collection of the latest medical coding books, illustrated guides, specialty handbooks, dictionaries, and sourcebooks. Stay on top of the latest CPT® coding guidelines, learn how to code flawlessly, and stay on course to successful claims and reimbursement in 2018.