CMS is replacing the CPT code you've been accustomed to using for flu vaccines and is adding five new Q codes, with an enforcement date of Jan. 1, 2011.
For dates of service starting Jan. 1, 90658 (flu vaccine, 3 years and older, $11.37) will no longer be payable. The five new Q codes are actually payable right now, and retroactively to Oct. 1, 2010. They are:
- Q2035 (Afluria)
- Q2036 (Flulaval)
- Q2037 (Fluvirin)
- Q2038 (Fluzone)
- Q2039 (Not Otherwise Specified flu vaccine)
You may submit claims with these new codes on an individual basis or via roster billing. NOTE: While these codes are retroactive to claims with dates of service on or after Oct. 1, 2010, your Medicare Administrative Contractor (MAC) or carrier may not be ready to process them until Feb. 7, 2011. By that date, all MACs will be required to process claims with these new Q codes. Until then, these Q codes may be held while MACs prepare their systems for the changes, CMS says.
To cut down on billing confusion, you can also hold claims containing the new Q codes until the Feb. 7 deadline.
Remember: Medicare patients often give excuses for avoiding flu shots, CMS says. There isn't a good one, because more than 90% of the 36,000 flu-related deaths every year occur in people of Medicare age, the agency says.