Flu Vaccination Coding and Billing for 2022-2023


Has your billing department prepared for the upcoming 2022-2023 influenza season?

As we approach the 2022-2023 influenza season, the Centers for Disease Control and Prevention (CDC) continues to recommend flu vaccination for everyone aged 6 months and older, with the ideal timing being by the end of October. This guidance remains consistent with previous years. However, there have been modifications to the Medicare Part B payment allowances for flu vaccines.

Coding and Billing for Flu Vaccination

Contrasting CPT® Codes and Medicare Part B Payment Allowances between the 2021-2022 and 2022-2023 Influenza Seasons

CodeVaccine NamePayment Allowance
cpt code 90662Fluzone High-Dose Quadrivalent$65.261$69.941
cpt code 90672FluMist Quadrivalent$26.876$26.876
cpt code 90674Flucelvax Quadrivalent (Pres Free)$29.940$32.278
cpt code 90682Flublok Quadrivalent$65.261$69.941

cpt code 90685

Fluzone Quadrivalent 0.25ml (Pres Free)
Afluria Quadrivalent 0.25ml (Pres Free)
cpt code 90686Fluarix Quadrivalent (Pres free)
Flulaval Quadrivalent (Pres Free)
Fluzone Quadrivalent (Pres Free)
Afluria Quadrivalent (Pres Free)
cpt code 90687Fluzone Quadrivalent 0.25ml
Afluria Quadrivalent 0.25ml
cpt code 90688Fluzone Quadrivalent
Afluria Quadrivalent
cpt code 90694Fluad Quadrivalent (2022-2023 – Pres Free)$66.426$71.682
cpt code 90756Flucelvax Quadrivalent$28.370$30.581

The payment allowances for influenza vaccines under Medicare Part B are typically set at 95 percent of the average wholesale price (AWP), with the exception being when the vaccine is administered in a hospital outpatient department, rural health clinic (RHC), or federally qualified health center (FQHC), in which case payments are determined based on reasonable cost.

It’s worth noting that the influenza vaccine coverage pertains to the annual flu season, spanning from August 1st to July 31st of the following year. Consequently, it’s feasible for a Medicare beneficiary to receive two fully-covered flu vaccinations within a single calendar year. For instance, if a patient receives a flu vaccine on January 5, 2022, and then again on August 29, 2022, Medicare would cover both claims.

Furthermore, it’s important to emphasize that the annual Part B deductible and coinsurance do not apply to influenza virus vaccinations