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Coding Guidelines for the Influenza, Pneumococcal, and Hepatitis B Vaccines

Procedure Codes

90655 Influenza virus vaccine, split virus, preservative free, for children 6-35 months of age, for intramuscular use
90656 Influenza virus vaccine, split virus, preservative free, for use in individuals 3 years and above, for intramuscular use (Fluarix)
90657 Influenza virus vaccine, split virus, 6-35 months dosage, for intramuscular or jet injection use
90658 Influenza, virus vaccine, split virus, 3 years and above dosage, for intramuscular or jet injection use
90660 Influenza virus vaccine, live, for intranasal use
90662 Influenza virus vaccine, split virus, preservative free, enhanced immunogenicity via increased antigen content, for intramuscular use
90669 Pneumococcal conjugate vaccine, 7 valent, for intramuscular use
90670 Pneumococcal conjugate vaccine, 13 valent, for intramuscular use
90732 Pneumococcal polysaccharide vaccine, 23-valent, adult or immunosuppressed patient dosage, for use in individuals 2 years and older, for subcutaneous or intramuscular use
90740 Hepatitis B vaccine, dialysis or immunosuppressed patient dosage (3 dose schedule), for intramuscular use
90743 Hepatitis B vaccine, adolescent (2 dose schedule), for intramuscular use
90744 Hepatitis B vaccine, pediatric/adolescent dosage (3 dose schedule), for intramuscular use
90746 Hepatitis B vaccine, adult dosage, for intramuscular use
90747 Hepatitis B vaccine, dialysis, or immunosuppressed patient dosage (4 dose schedule) for intramuscular use
G0008 Administration of influenza virus vaccine
G0009 Administration of pneumococcal vaccine
G0010 Administration of hepatitis B vaccine
Q2035 Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Afluria)
Q2036 Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Flulaval)
Q2037 Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Fluvirin)
Q2038 Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Fluzone)
Q2039 Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (not otherwise specified)

Covered ICD-9 Codes

V03.82 Vaccine for Streptococcus Pneumonia (PPV)
V04.81 Vaccine for Influenza Virus
V06.6 Streptococcus pneumoniae [pneumococcus] and influenza
V05.3 Vaccine for Viral Hepatitis (Hepatitis B)

Effective for dates of service on or after October 1, 2006: Providers report diagnosis code V06.6 in place of V03.82 and V04.81 when reporting PPV and/or influenza virus vaccines when the purpose of the visit was to receive both vaccines.

  1. General

    1. Submit all claims for the vaccines (all drug and biologicals) as assigned.
    2. Assignment for administration is not mandatory, unless the provider is enrolled as a "Mass Immunizer," submits roster bills, or participates in the centralized billing program.
    3. Report the patient's diagnosis or condition with an ICD-9 code. Code the ICD-9 code to the highest level of specificity, listing the primary condition in the first position in Item 21 on Form CMS-1500 (08-05) or the electronic equivalent.
    4. Report the appropriate CPT code for the procedure(s) performed.
    5. If applicable, use the appropriate modifier. Modifiers direct prompt and correct payment of the claims submitted.
    6. Submit separate claims when two different entities furnish the vaccine and the administration.
    7. Special instructions for PPV billed EMC or CMS-1500 (08-05) claim form.
      • Form CMS-1500 (08-05) must have information in Item 19 stating one of the following:
        • Unknown date of last PPV;
        • No, the patient has not had the PPV within the last five years; or
        • Yes, the patient has had PPV within the last five years.
      • Electronic claims must have the above information in the narrative record: loop 2300, 2-190 NTE02
  2. Miscellaneous

    1. Hepatitis B vaccine (90740, 90743, 90744, 90746, 90747) and/or its administration (G0010). Identify the name and NPI of the ordering physician Item 17 of the CMS-1500 (08-05) or for electronic claims:
      • Referring Physician NPI: loop 2310A, 2-271 REF02 (1G)
      • Referring Physician Last Name: loop 2310A, 2-250 NM103 (DN)
      • Supervising Physician First Name: loop 2310A, 2-250 NM104
  3. Roster Billing for PPV and Influenza Virus Vaccination Programs

    1. WPS Medicare will return rosters that are incorrectly or partially completed or are not legible.
    2. Do not use rosters for single patient billing.
    3. Roster billing for PPV must have the PPV column completed for reimbursement.

Page Last Updated: Wednesday, 17-Apr-2013 15:13:09 CDT