CPT code and description
90630 – Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, for intradermal use
90653 – Influenza vaccine, inactivated (IIV), subunit, adjuvanted, for intramuscular use
90654 – Influenza virus vaccine, trivalent (IIV3), split virus, preservative-free, for intradermal use
90655 – Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, 0.25 mL dosage,for intramuscular use
90656 – Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, 0.5 mL dosage, for intramuscular use
90657 – Influenza virus vaccine, trivalent (IIV3), split virus, 0.25 mL dosage, for intramuscular use
90658 – Influenza virus vaccine, trivalent (IIV3), split virus, 0.5 mL dosage, for intramuscular use
90660 – Influenza virus vaccine, trivalent, live (LAIV3), for intranasal use
90661 – Influenza virus vaccine, trivalent (ccIIV3), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage, for intramuscular use
90662 – Influenza virus vaccine (IIV), split virus, preservative free, enhanced immunogenicity via increased antigen content, for intramuscular use
90672 – Influenza virus vaccine, quadrivalent, live (LAIV4), for intranasal use
90673 – Influenza virus vaccine, trivalent (RIV3), derived from recombinant DNA, hemagglutinin (HA) protein only, preservative and antibiotic free, for intramuscular use
90674 – Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit,preservative and antibiotic free, 0.5 mL dosage, for intramuscular use
90682 – Influenza virus vaccine, quadrivalent (RIV4), derived from recombinant DNA,hemagglutinin (HA) protein only, preservative and antibiotic free, for intramuscular use
90685 – Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, 0.25 mL dosage, for intramuscular use
90686 – Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, 0.5 mL dosage, for intramuscular use
90687 – Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.25 mL dosage, for intramuscular use
90688 – Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.5 mL dosage, for intramuscular use
90689* – Influenza virus vaccine, quadrivalent (IIV4), inactivated, adjuvanted, preservative free, 0.25mL dosage, for intramuscular use
90756 – Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, antibiotic free, 0.5mL dosage, for intramuscular use
Q2034 – Influenza virus vaccine, split virus, for intramuscular use (agriflu)
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)
90670 – Pneumococcal conjugate vaccine, 13 valent (PCV13), for intramuscular use
90732 – Pneumococcal polysaccharide vaccine, 23-valent (PPSV23), adult or immunosuppressed patient dosage, when administered to individuals 2 years or older, for subcutaneous or intramuscular use
90739 – Hepatitis B vaccine (HepB), adult dosage, 2 dose schedule, for intramuscular use
90740 – Hepatitis B vaccine (HepB), dialysis or immunosuppressed patient dosage, 3 dose schedule, for intramuscular use
90743 – Hepatitis B vaccine (HepB), adolescent, 2 dose schedule, for intramuscular use
90744 – Hepatitis B vaccine (HepB), pediatric/adolescent dosage, 3 dose schedule, for intramuscular use
90746 – Hepatitis B vaccine (HepB), adult dosage, 3 dose schedule, for intramuscular use
90747 – Hepatitis B vaccine (HepB), dialysis or immunosuppressed patient dosage, 4 dose schedule, for intramuscular use
Recommend Influenza Vaccination: Each Office Visit is an Opportunity
People 65 years and older are at greater risk for serious influenza-related complications. The Centers for Disease Control and Prevention (CDC) recommends annual influenza vaccination for everyone 6 months and older. Your strong vaccine recommendation is a critical factor that affects whether your patients get an influenza vaccine. Take time to recommend and vaccinate your patients, your staff, and yourself.
Medicare Part B covers the influenza virus vaccine once per influenza season. Medicare covers additional influenza vaccines if medically necessary.
You may also want to recommend the pneumococcal vaccine during the same visit. Medicare covers:
An initial pneumococcal vaccine for Medicare beneficiaries who never received the vaccine under Medicare Part B
A different, second pneumococcal vaccine 1 year after the first vaccine was administered
Does the Medicare Part B deductible, coinsurance, or copayment apply for Part B-covered immunizations?
When physicians or suppliers agree to accept assignment, the Part B deductible, coinsurance, or copayment do not apply to the seasonal influenza virus, pneumococcal, and Hepatitis B vaccines or their administration.
If a beneficiary gets a seasonal influenza virus vaccine twice in a 12-month period, will Medicare still pay for it?
Yes, Medicare pays for one seasonal influenza virus vaccination per influenza season; however, a beneficiary could get the seasonal influenza virus vaccine twice in a calendar year for two different influenza seasons, and Medicare would pay the provider for each. For example, a beneficiary who received a seasonal influenza virus vaccination in January 2018 for the 2017–2018 influenza season could receive another seasonal influenza virus vaccination in November 2018 for the 2018–2019 influenza season, and Medicare would pay for both vaccinations.
Should providers administer the pneumococcal vaccination if a beneficiary is uncertain of his or her vaccination history?
Yes, if a beneficiary is uncertain about his or her vaccination history, and the provider cannot obtain verification from the beneficiary’s medical records, provide the vaccine. Medicare beneficiaries are eligible for the initial pneumococcal vaccine and a different pneumococcal vaccine one year after the first vaccine (at least 11 months have passed following the month when the last pneumococcal vaccine was administered).
Beneficiaries may be liable for the costs of the revaccination if they exceed the benefit maximum or if the timing of these services is sooner than the required 11 full months following the month of the last pneumococcal vaccine. We encourage providers to closely track vaccination history.
Does Medicare cover the hepatitis B vaccine for all Medicare beneficiaries?
No, Medicare covers the hepatitis B vaccine for certain beneficiaries at intermediate to high risk for the hepatitis B virus (HBV). These individuals include health care professionals who have frequent contact with blood or blood-derived body fluids during routine work, individuals with End-Stage Renal Disease (ESRD), individuals living with an HBV carrier, and individuals diagnosed with diabetes mellitus. Other situations could qualify a beneficiary as being at intermediate or high risk of contracting HBV. Medicare beneficiaries not eligible for this benefit are those currently positive for hepatitis B antibodies.
When a beneficiary gets both the seasonal influenza virus and pneumococcal vaccines on the same visit, do I continue to report separate administration codes for each type of vaccine?
Yes, use separate administration codes for the seasonal influenza virus (G0008) and pneumococcal (G0009) vaccines. Medicare pays both administration fees if a beneficiary gets both vaccines on the same day.
Can I roster bill the seasonal influenza virus, pneumococcal, and hepatitis B vaccines?
You may roster bill the seasonal influenza virus and pneumococcal vaccines. You cannot roster bill the hepatitis B vaccine.
What is a mass immunizer?
A mass immunizer offers seasonal influenza virus vaccination, pneumococcal vaccination, or both to many individuals. A mass immunizer may be a traditional Medicare provider or supplier or a nontraditional provider or supplier (such as a senior citizens’ center, a public health clinic, or a community pharmacy). Mass immunizers must submit claims for immunizations on roster bills and must accept assignment on the vaccine and its administration. A mass immunizer should enroll with the Medicare Administrative Contractor (MAC) prior to each influenza season. Please see the next question for more enrollment information.
Do providers only providing immunizations need to enroll in the Medicare Program?
Yes, providers must enroll in the Medicare Program even if immunizations are the only service they provide to beneficiaries. They should enroll as provider specialty type 73, Mass Immunization Roster Biller, by completing Form CMS-855I for individuals or Form CMS-855B for a group. New providers must receive an NPI prior to enrollment. To obtain an NPI if you do not already have one, register through the Identity & Access Management System, then go to the National Plan & Provider Enumeration System.
May I submit a single roster claim for the seasonal influenza virus and pneumococcal vaccines when the vaccines are administered on the same visit?
No, you must prepare a separate roster claim for the seasonal influenza virus vaccine and the pneumococcal vaccine. However, you may file an individual claim for both vaccines.
