MACs to pay flu virus vaccine CPT code – in April

by: Nick Stern and Richard Scott Dec 29, 2015

Make sure your billing staff know CMS has issued a change request to include influenza virus vaccine CPT code 90630 (Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, for intradermal use) for claims with dates of service on or after Aug. 1, 2015.

These claims will be held until they are processed and paid on or after April 4, 2016, CMS says in a new MLN Matters article. That could be a sizable chunk of change that you're waiting on, as 90630 pays $23.47 per vaccine, according to Medicare payment data (PBN 9/28/15).

Your agency’s Medicare administrative contractor (MAC) will add the influenza virus vaccine CPT code to existing influenza virus vaccine edits and accept it for claims with dates of service on or after Aug. 1, 2015.

Note that annual Part B deductible and coinsurance do not apply.

Blog Tags: CMS, provider compensation

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