Flu Shots

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Flu Shots Given – Charges Denied

Flu ShotsNew codes for flu shots in 2017!

By:  Claire Ariyoshi, MBA, CPC

The flu season is underway and the Center for Disease Control (CDC) is recommending that people get their flu shots.  According to the CDC, only injectable flu shots are recommended this season.

Health care providers have been providing flu shots to their patients in record numbers.  However, some providers are now left wondering why their charges are being denied by various insurance carriers.  If this is happening to you, it may be because you are using the wrong codes.  Following is a summary of how providers must code in order to be paid.

Effective January 1, 2017, many influenza codes were revised to remove the age indicator and a dosage is now required. The table below illustrates these changes.

REVISED Influenza codes

2016 (age of patient) January 1, 2017 (Dosage)

90655, 90657, 9085,90687

6 – 35 months

0.25 mL dosage

90656, 90658, 90686, 90688 Older than 3 years

0.5 mL dosage

Providers who have followed these coding guidelines are being reimbursed in accordance with the carriers policies.Additionally, a new CPT 90674 has been added for a quadrivalent cell cultured influenza vaccine that is indicated for use in those 4 years of age or older.

Claire Ariyoshi is the Vice President of Finance for Onpoint Medical Solutions.  She has over 30 years experience managing medical billing and patient registration departments for private practices.  In addition to her MBA, she is a certified professional coder and is ICD-10 certified.