Tag Archives: 90658

Replace 90658 With a Q Code, After Jan. 1

Posted on 08. Dec, 2010 by .

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Get ready to change your flu vaccine product code 90658 to one of four Q codes.

For 2010, report 90658 (Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use) to signify that your physician administered a vaccine with preservatives to a patient over the age of three. Medicare will no longer pay for claims with 90658 “effective for claims with dates of service on or after Jan. 1, 2011,” according to MLN Matters article MM7234.

Instead, you’ll have to bill based on the specific brand-name flu vaccine that the physician administers using the following new HCPCS level II codes:

  • Q2035 – Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use; Afluria
  • Q2036 – Flulaval
  • Q2037 – Fluvirin
  • Q2038 – Fluzone
  • Q2039 – Not otherwise specified.

Important: Don’t start submitting the new codes just yet. The…

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CMS Releases Payment Amounts for Flu Shots

Posted on 10. Nov, 2010 by .

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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,

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

Posted on 09. Sep, 2009 by .

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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…

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