Code Change for Influenza Season 2020-2021

new influenza virus vaccine codeThe 2019-2020 influenza season is winding down, so now is a good time to start preparing for the 2020-2021 influenza season. Let’s start with a new CPT® code for the flu vaccine.

Flu Activity Report

The Centers for Disease Control and Prevention (CDC) reports that viral activity is decreasing in the United States. According to a CDC Weekly U.S. Influenza Surveillance Report, as of the last week of February, labs are seeing a decline in respiratory specimens testing positive for flu, down from 28 percent the week prior to 24.3 percent. Hospitalizations and deaths remain moderate to low, overall.

The CDC estimates that between Oct. 1, 2019, and Feb. 29, 2020, there have been 34-49 million flu-related illnesses in the United States, with 350,000–620,000 cases requiring hospitalization, and 20,000–52,000 cases resulting in death.

Remember when the H1N1 pandemic caused such a ruckus? The H1N1 virus surfaced in the United States in 2009 and is now a common human flu virus that circulates seasonally worldwide. The prevalent strain for 2019-2020 is A(H1N1)pdm09.

New CPT® Vaccine Code for 2020-2021 Season

MLN Matters article MM11603, issued Jan. 31, updates the Medicare Physician Fee Schedule Database (MPFSDB) with one new influenza virus vaccine code for the 2020-2021 flu season:

90694 Influenza virus vaccine, quadrivalent (allV4), inactivated, adjuvanted, preservative free, 0.5 mL dosage, for intramuscular use

CPT® 90694 is effective July 1, 2020. The Medicare Part B Drug and Biological Average Sales Price Quarterly Payment files for calendar year 2019 were last updated Feb. 20. This new code will appear in the July 1 quarterly payment files.

Medicare Administrative Contractors are instructed in a related transmittal to modify existing editing to allow the flu vaccine and pneumococcal polysaccharide vaccine on the same date on separate roster bills.

Generally, healthcare providers get a short break between flu seasons, but not this year: COVID-19 is keeping everyone busy. This new virus will likely become a part of the seasonal vaccines, too, once one is created.

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