On Aug. 1, the Centers for Medicare & Medicaid Services (CMS) increased payments to physicians for influenza vaccines and updated which codes physicians should use when billing for the service during the 2024-25 flu season.
Physicians should bill CPT codes 90653 – 90673 depending on which flu vaccine they use. These codes have payment allowances varying from $10.93 to $83.49, an overall increase from last year. During the 2023-24 flu season, the highest amount Medicare paid physicians for flu vaccines was $77.36.
All CPT codes became active Aug. 1 and will remain in use until July 31, 2025. CMS revises the code list annually.
Texas Medical Association billing and coding staff caution that to receive payment, physicians also will need to use a national drug code (NDC) associated with the current period.
The Centers for Disease Control and Prevention (CDC) recommend annual flu shots for every patient six months and older each flu season. CMS states that Medicare Part B covers the seasonal flu shot and Medicare covers additional flu shots if medically necessary. Patients can receive flu shots twice in a calendar year during two different flu seasons, and Medicare will pay for both shots.
For more information about billing and coding, visit the TMA’s Billing, Coding, and Payment Resources page.
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Last Updated On
September 09, 2024
Originally Published On
September 09, 2024
Alisa Pierce
Reporter, Division of Communications and Marketing
(512) 370-1469