For the influenza season from August 1 to July 31 of the following year, the Centers for Disease Control and Prevention (CDC) advises that individuals 6 months and older should ideally receive an influenza vaccine by the end of October. This recommendation remains consistent with previous years, but there have been adjustments to the Medicare Part B reimbursement rates for flu vaccines for the 2023-2024 season. You can bill for influenza vaccine administration and vaccine products with dates of service from Aug. 1, 2023, through July 31, 2024. There has been a slight increase in Medicare Part B payment allowances for the 2023-2024 flu season. Refer to the CPT codes for 2023 below.
Influenza Billing Codes for Medicaid/Medicare Beneficiaries Less Than 19 Years of Age Who Receive VFC Influenza Vaccine. These codes are reported with $0.00.
| Vaccine CPT Code to Report | CPT Code Description |
| 90672 | Influenza virus vaccine, quadrivalent, live (LAIV4), for intranasal use |
| 90674 | Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, preservative and antibiotic-free, 0.5 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, for intramuscular use |
| 90688 | Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.5 mL dosage, for intramuscular use |
Influenza Vaccine Billing Codes for Beneficiaries 19 to 21 Years of Age
Use the following codes to bill Medicaid/ Medicare for an influenza vaccine purchased and administered to beneficiaries aged 19-21.
Vaccine CPT Codes to Report
| Vaccine CPT Code to Report | CPT Code Description |
| 90672 | Influenza virus vaccine, quadrivalent, live (LAIV4), for intranasal 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 |
| 90686 | Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, 0.5 mL dosage, for intramuscular use |
| 90688 | Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.5 mL dosage, for intramuscular use |
| 90756 | Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, antibiotic free, 0.5 mL dosage, for intramuscular use |
Administrative CPT Codes to Report
| Administrative CPT Code(s) to Report | CPT Code Description |
| 90471EP | Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); one vaccine (single or combination vaccine/toxoid) |
| +90472EP (add-on code)* | Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); each additional vaccine (single and combination vaccine/toxoid) (List separately in addition to code for primary procedure). |
| 90473EP | Immunization administration by intranasal or oral route; 1 vaccine (single or combination vaccine/toxoid). Do not report 90473 in conjunction with 90471. |
* 90472 will only be used if another vaccine is given in addition to the flu vaccine. Providers may bill more than one unit of 90472 as appropriate.
General Guidelines for Influenza Vaccine Medical Billing
Medical billing for influenza vaccines in 2023 follows the standard procedure for submitting claims to insurance or government healthcare programs like Medicare or Medicaid. Here’s a general outline of the process:
- Verify Patient Eligibility: Confirm the patient’s influenza vaccine eligibility based on age and other criteria.
- Administer the Vaccine: Administer the influenza vaccine to the patient following appropriate medical guidelines.
- Document the Service: Document the vaccine administration, including the date, dosage, and relevant patient information in the medical record.
- Select the Correct CPT Code: Choose the appropriate Current Procedural Terminology (CPT) code for the specific influenza vaccine administered. The specific code may vary depending on the type of vaccine and whether it is a first or subsequent dose.
- Verify Coverage and Reimbursement: Check with the patient’s insurance provider or the relevant government healthcare program (e.g., Medicare or Medicaid) to ensure vaccine coverage and determine the reimbursement rates.
- Complete the Claim Form: Fill out a claim form (e.g., CMS-1500 for Medicare) with the patient’s information, diagnosis code (if required), CPT code for the vaccine, and any other necessary details.
- Submit the Claim: Submit the completed claim form electronically or by mail to the patient’s insurance or the appropriate government healthcare program.
- Follow-up: Monitor the claim status to ensure it is processed and paid appropriately. Address any denials or issues promptly.
- Patient Responsibility: If applicable, inform the patient of any out-of-pocket expenses, co-payments, or deductibles they are responsible for.
- Billing Documentation: Keep copies of all documentation, including the claim form, for your records.
It’s important to note that influenza vaccine billing procedures may vary depending on the type of vaccine used by the healthcare provider, the insurance company, and the government program guidelines. Consult with your billing department or medical billing service to ensure accurate and compliant billing practices for influenza vaccines in 2023.
