New flu shot codes and payment allowances go into effect each year on Aug. 1 for Medicare, allowing vaccination efforts to begin as soon as the seasonal influenza vaccine is available. To determine the correct vaccine code, you need to know the following:
For example, here are two commonly used codes and their associated products:
| Code | Labeler name | Drug name | Payment allowance |
| 90686, “Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, 0.5 mL dosage, for intramuscular use.” | GlaxoSmithKlineSanofi PasteurSeqirus | Fluarix quadrivalent (2019/2020) (preservative free) Flulaval quadrivalent (2019/2020) (preservative free) Fluzone quadrivalent (2019/2020) (preservative free) Afluria quadrivalent (2019/2020) (preservative free) | $19.03 |
| 90688, “Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.5 mL dosage, for intramuscular use.” | GlaxoSmithKlineSanofi PasteurSeqirus | Flulaval quadrivalent (2019/2020) Fluzone quadrivalent (2019/2020) Afluria quadrivalent (2019/2020) | $17.84 |
For a full list of current codes and payment allowances for flu vaccines billed to Medicare Part B, see Seasonal Influenza Vaccines Pricing(www.cms.gov). Codes not included in the full list likely represent products not available for the current flu season.
Lastly, don’t forget the immunization administration code.
