Influenza Vaccine Billing Guidelines for 2024-25

/ Healthcare News

Get Ready for the 2024-2025 Flu Season: What You Need to Know

Flu season is approaching. It is important that you remind your patients to receive their annual flu shots, especially between September and October.

Vaccination Age limit

Everyone aged six months and older should get a flu shot each year.

  • Best Time: Encourage patients to get their vaccine in September or October for the best protection.

Medicare Coverage for Flu Shots

  • Cost: Medicare Part B covers the flu vaccine at no cost to the patient if the provider agrees to the payment terms.
  • Frequency: Patients can get the flu vaccine twice a year if necessary, and it will be fully covered.
  • No Extra Fees: There are no copays or deductibles for the flu shot.

Billing guidelines

  • Use ICD-10- Z23
  • Claim Submission:
    • Roster Billing: You can bill for a group of patients who received the vaccine on the same day.
    • Centralized Billing: Large vaccination events can submit claims to Novitas Solutions for flu, COVID-19, and pneumonia vaccines electronically.

Payment Information

  • Stay Updated: Check for the latest Medicare payment rates for the 2024-2025 flu season to ensure accurate billing.

Next Steps

  1. Remind Patients: Reach out to patients and encourage them to get their flu shots.
  2. Stay Informed: Keep up with Medicare updates on payments and billing.
  3. Train Your Staff: Make sure your team understands the billing process to make vaccinations go smoothly.

List of influenza vaccination billing codes based on the vaccine dose and the patient's age.

Administration Codes for Influenza Vaccines

HCPCS Codes for Vaccine Administration [Medicare and other health insurance providers.]

  • G0008

CPT Code for Live Vaccinations

  • CPT Code 90471: This code is used for billing a live attenuated vaccination (like the flu shot) given via any method (percutaneous, intradermal, subcutaneous, or intramuscular).

Patient Communication

Make sure to include information about the influenza vaccine as part of your annual preventative care services. This is crucial for encouraging patient participation and ensuring they receive their vaccinations.

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