CMS Releases Payment Amounts for Flu Shots

Posted on 10. Nov, 2010 by jennifer.godreau.

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.

Continue Reading

4 Coding & Billing Steps Boost Your Flu Prevention Pay by $38

Posted on 09. Sep, 2009 by .

Do you know how old the patient is? If you don’t, here’s how you’re losing reimbursement.

A pediatric practice recently asked Pediatric Coding Alert for money-making tips as staff gear up for flu season. “In the past, we have had difficulty in just breaking even for the cost of the influenza vaccine,” wrote the subscriber. “How can we be reimbursed by private insurances at the best rate of return?” she asked.

Here’s how to clear several coding pitfalls that can sink flu vaccination payments. “Make sure you code correct route, correct product, correct ICD-9,” says Cathy Gray, RHIT, CCS, CPC-I, CCC, CGIC, with Henry Ford Health System in Detroit.

1: Avoid Losing $10 by Checking Preservative-Free

Look at the manufacturer’s box to verify that you’re reporting the correct product code for the influenza product the patient is receiving. Preservative-free products, including Fluzone No Preservative, Fluvirin Preservative-Free, and Fluarix, cost more and should reimburse at a higher rate than non-preservative-free products (Fluzone and Fluvirin). Intranasal product FluMist (90660, Influenza virus vaccine, live, for intranasal use) pays the most ($22.316 using 2008 rates).

Don’t miss the Pediatric Specialty Coding & Billing Conference in Orlando this December. Click here to see the great sessions planned with Donelle Holle, Jennifer Godreau, Dr. Richard Tuck & more.

Example: If a patient received Fluzone No Preservative Pediatric and you incorrectly used the regular product code (90657, Influenza virus vaccine, split virus, when administered to children 6-35 months of age, for intramuscular use), rather than the preservative-free product code (90655, Influenza virus vaccine, split virus, preservative free, when administered to children 6-35 months of age, for intramuscular use), you would lose $10 in reimbursement. The payment allowance for the preservative-free pediatric product code (90655) is $16.879 compared to $6.609 for the same-age approved regular product code (90657).

Continue Reading