.

Call Now 703-327-1800

Contact    Blog       About     Resources      Medical Billing Services

  

How to Bill Flu Shots

Health Insurance Companies Process 1 in 5 Claims Wrong

How to Bill Flu Shots

Billing Flu Shots to Medicare and Commercial Insurance Companies

Since it is now flu season I have been getting a lot of questions on how to bill flu shots to commercial insurance companies and Medicare. The codes used for a particular vaccine will vary depending on intramuscular vs. intranasal use, age of patient, formulation, preservative free, and split or live virus. If you are unsure of what code to use I suggest looking at the package information
that came with the vaccine. Usually you can find the code on the packaging, and if you can’t find it in the documentation then call the supplier.

This is how most of our primary care practices bill for flu shots. Your situation may be different so make sure to check all the influenza vaccine codes 90654-90668 and use the appropriate code for the vaccine administered to the patient.

Commercial Insurance Carriers

90471 Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 vaccine (single or combination vaccine/toxoid)
90658 Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use

Medicare

G0008 Administration of Influenza Virus Vaccine
Q203x Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use

Keep in mind that there are several codes for the flu vaccine when you bill for Medicare flu shots. The code you use is dependent on the manufacturer of the vaccine. Replace the code above with the correct vaccine code below.

Here is the list of the Medicare Flu Vaccine codes. Choose the code based on the manufacture:

Q2034 Agriflu Vaccine: Influenza virus vaccine, split virus, for intramuscular use (Agriflu)

Q2035 Afluria Vaccine: Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Afluria)

Q2036 Flulaval Vaccine: Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Flulaval)

Q2037 Fluvirin Vaccine: Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Fluvirin)

Q2038 Fluzone Vaccine: Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Fluzone)

Q2039 NOS (Not Otherwise Specified) Vaccine: Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Not Otherwise Specified)

Check out the short video we made about coding for the Medicare flu shot CLICK HERE

Pediatric Billing

Flu Shot Pediatric BillingIf a child is under the age of 9 and has not previously received a flu shot, then usually two shots are given one month apart. After the initial series, in subsequent years only one shot is needed. When billing for the initial flu shot keep in mind that insurance should pay for both the initial flu shot and the flu shot given 30 days later. Be sure to follow up with the insurance companies if reimbursement is not issued for the second shot of the initial series. Typically these are denied but can be paid with a simple appeal or phone call correcting the denial.

90471 Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 vaccine (single or combination vaccine/toxoid)

Use the age appropriate codes as needed.
90657 Influenza virus vaccine, split virus, when administered to children 6-35 months of age, for intramuscular use
Or
90658 Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use

Print Post & Download PDFCPT copyright 2010 American Medical Association. All rights reserved.
CPT is a registered trademark of the American Medical Association.

is a 20 year veteran of healthcare having managed medical practices. He advises medical practices, physicians and practice administrators on how to run their practice and manage their medical billing and revenue cycle management. Manny speaks, blogs and makes videos at www.CaptureBilling.com, a blog that is tops in the medical billing and coding field. READ MORE

If You Liked This Post You Will Love These

115 Responses to How to Bill Flu Shots

  1. I would recommend that you provide an updated article since this one references information and codes for 2011.There are new codes and new recommendations.

  2. Anyone have experience in billing flu shot for MN Medicaid. I know the DX code is Z23 but which CPT and modifier do you use. I submitted a couple and always denied.

    • Par look at the following codes:

      90471 Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 vaccine (single or combination vaccine/toxoid)

      90658 Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use

      That said, MN Medicaid may have their own set of requirements to bill. Best to contact them or go to their website. Medicaid may have the policies to bill the flu vaccine properly according to their guidelines on the site.

  3. I own a mobile phlebotomy and health service company and want to start giving flu shots and vaccines. How do I bill and accept insurance? I live in California.

    • Andrea first you will have to get credentialed with each insurance company if you can. Give one a call to get the process started. It can take 2-6 months. Once you are credentialed and have a contract with the insurance company you can submit claims as an in-network provider. You can still bill insurance if you don’t have a contract but will be considered out-of-network and insurance may not pay or pay the patient directly or have higher out of pockets for the patient.

  4. I have billed out office visits (pt in for a sick visits peds) 99213 and when flu shot was given, we used mod-25, SL and admin fee 90460 on our AZ AHCCCS (medicaid) patients, but the office visit gets denied. When i called ins comp they just repeat the same line that it wasn’t coded properly but they can’t help me with what the proper coding is and refer me to their web site which id no help.

  5. Thank you for the information! I am researching how to code for 1/2 doses of flu in children and elderly and they come back 28 days later for the other 1/2.

    My thought process is we will bill for the flu vaccine on inital DOS, but not the follow up. If we don’t have a vaccine to bill out on the second DOS, we would also not have an admin fee.

    Any help would be greatly appreciated.

    Thank you!

  6. Hi,

    We do send claims for Maryland state, I am encountering the following problems with all Medicaid groups – eg- uhc mid atlantic, Maryland physicians care, amerigroup,americaid, etc…
    while we bill 99213 – 25 – 401.1 and 90658 -v04.81 and 90471- V04.81 , always administration code is denied stating STATUTORILY EXCLUDED SERVICE, but who is going to pay our administration services.
    Its been a long time issue, need help Manny

    • Sue each state’s Medicaid program is different. Unfortunate we don’t have any clients that bill Medicaid flu shots in Maryland so I may not be much help to you. I would not be surprised that Medicaid HMOs don’t cover the admin code. Is it possible that there is another code they would like you to use instead? Maybe becasue you have an office visit they are excluding the admin.

      I would contact your rep and check on the Medicaid and HMOs websites for their guidelines on billing flu shots. Also I would not use a 25 modifier on the visit. It is not necessary in this case unless it is a carrier specific rule. You are using ICD-10 codes? Z23 Encounter for immunization.

  7. Oh boy, I have not billed my medicare flu billings yet, however they have been getting paid with my billing to third party insurance companies, and I use the G0008 & Q2035 $15.00 for each code and I use the diagnosis code Z23. I am at a loss on that one, if insurance pays out why won’t medicare???? Sorry no help at this point, I will let you know how mine pay or don’t pay when I bill them. I plan to use the same codes as you mentioned. urrrrrr………..

  8. We are billing flu injections to Medicare with a G0008 administration code and the appropriate vaccine code with a diagnosis code of V04.81 for ICd-9 (Before October 1st) and Z23 for ICd-10 (after October 1st) and the G0008 code is being denied. We have called Medicare and they tell us that they do not cover the administration (G0008) with the diagnosis codes were are using because it is routine? Everything we look at says to use one of these two diagnosis codes for the admin and vaccine. Does anyone have any idea why they aren’t paying? What other diagnosis code could we possibly use?

  9. Hello. Would you be so kind as to tell me which modifiers I use for codes Q2037 if any and for 90732 for Medicare for 2015??? Trying to find out without having to call the boss. I haven’t used these codes since last year and don’t know what to do. Thank you so much for your help, I appreciate. Barbara Wright

Leave a reply

Who Are We?

Capture Billing helps medical practices by reducing their insurance accounts receivable and getting claims paid faster, allowing doctors to focus on providing quality healthcare to their patients without the stress of doing their own medical billing.

That’s why we developed Capture Billing’s Rapid Revenue Recovery System to keep our clients’ Accounts Receivables down and their revenue flowing.

Learn More

Disclaimer

The analysis of any medical billing or coding question is dependent on numerous specific facts -- including the factual situations present related to the patients, the practice, the professionals and the medical services and advice. Additionally, laws and regulations and insurance and payer policies (as well as coding itself) are subject to change. The information that has been accurate previously can be particularly dependent on changes in time or circumstances. The information contained in this web site is intended as general information only. It is not intended to serve as medical, health, legal or financial advice or as a substitute for professional advice of a medical coding professional, healthcare consultant, physician or medical professional, legal counsel, accountant or financial advisor. If you have a question about a specific matter, you should contact a professional advisor directly. CPT copyright American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.

Learn how to outsource your Medical Billing today

CALL NOW  703-327-1800

Client Testimonials

Bob Laird

OBGYN COO

I would recommend Capture Billing to anyone who needs a billing company they can trust.

Bob Laird

Steve Rex

Family Practice

In a six month period Capture Billing increased our Practice’s income by over $100,000.

Steve Rex

Julie Reed-Humeniuk

Family Practice

Capture Billing goes over and beyond the call of duty for their clients to maximizing reimbursement.

Julie Reed-Humeniuk

CaptureBilling.com - Medical Billing Services

Capture Billing is a Medical Billing Company based in South Riding Virginia.

Join the other Doctors and Practice Managers that have benefited from our expert medical billing services.


Capture Billing & Consulting Inc.
25055 Riding Plaza #160
South Riding, VA 20152
Phone: (703) 327-1800

MENU