CMS Releases Payment Amounts for Flu Shots

November 10, 2010

Forget about digging through the latest Medicare Physician Fee Schedule and calculating the conversion factor when it comes to determining your Part B reimbursement rate for flu shots. CMS has come out with a handy MLN Matters article explaining this information. According to MLN Matters article MM7120, released on Oct. 22, the Part B payment allowance for flu immunizations is as follows:

90655 (Influenza virus vaccine, split virus, preservative free, when administered to children 6 to 35 months of age, for intramuscular use): $12.398.
90656 (Influenza virus vaccine, split virus, preservative free, when administered to individuals 3 years and older, for intramuscular use): $12.375.
90657 (Influenza virus vaccine, split virus, when administered to children 6 to 35 months of age, for intramuscular use): $6.297.
90658 (Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use) for dates of service Sept. 1, 2010 through Dec. 31, 2010: $11.368.

If your MAC reimburses for either 90660 (FluMist) or 90662 (Fluzone High-Dose), the Part B payment amount effective Sept. 1 for 90660 is $22.316, and for 90662 is $29.213. Carriers differ on whether they will cover these types of influenza immunizations.

Annual Part B deductible and coinsurance amounts do not apply to these charges, the article notes.

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