Coding for Medicare Flu Shots Q2035, Q2036, Q2037, Q2038
New Medical Billing Guidelines
Watch the coding for Medicare flu shots video and learn that as of January 1, 2011 if you bill Medicare CPT Code 90658, for the Influenza Virus Vaccine, you will not get paid. Medicare has established five separate influenza vaccine Q Codes to distinguish between the brand-names of influenza vaccines.
The HCPCS code G0008 Administration of Influenza Virus Vaccine must still be used for the administration of the flu vaccine for Medicare patients.
What are the New Influenza Vaccine Codes?
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)
Additional information direct from Medicare on medical billing for influenza vaccines can be found at: http://www.cms.gov/MLNMattersArticles/downloads/MM7234.pdf
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Dear Mr. Oliverez,
I billed medicare for Flu vaccine with Q2036 and G0008. It was rejected with remarks M25 and N29.
I use fluval for vaccination. I have givenMore than 250 vaccinations. please advise
Dr. Venkatesh
Our practices have been using those same codes, G0008 and Q2036 with V04.81 and are getting paid by Medicare. I looked up the denial reason codes and they really don’t make much sense for a flu shot. What ICD-9 code are you using? Looks like you will have to have your billing people call Medicare and find out what is going on.
When billing Medicare we use the CPT G0008. Should we also use the CPT codes 90471 without office visit and 90460 visits with office visit?
Diane thanks for your question. There is only one administration code for Medicare flu shots and that is G0008. CPT Code 90471 or 90460 would not be used for the flu admin code for Medicare. Also just an FYI, 90471 may be appropriate without an office visit but 90460 may not be appropriate even if there is an office visit.
I have submitted G0008 and Q2038. They also had a 99214 visit for different reason. Medicare is not paying G0008 with reason codes COB15 and M80. I never had a problem with getting paid for administration before. Pleas help.
We frequently bill problem visits with the flu vaccine and administration and have not had any issues getting reimbursement for all three line items you’ve indicated above. Did you append modifier -25 to the office visit? If not we recommend you resubmit the claim with the 99214-25. This should alleviate the reimbursement issue. Also make sure that the referring physician is indicated (even for our family practice we have to put in the referring physician – we use the actual PCP even if it is one of our own doctors) because otherwise the claim will be denied for missing/invalid information.