Medicare All Set to Pay for Latest Influenza Code, 90674

The Centers for Medicare & Medicaid Services (CMS) declared in a recent  that Medicare will pay for the latest CPT influenza virus vaccine, 90674. But because 2017 codes will not go into effect until after the 1st of the year; until January 3, 2017 payments will not start. Although, claims with dates of services will be covered on or after August 1, 2016.

90674 Newest in Series of Flu Codes
CPT 90674 Influenza virus Vaccine, quadrivalent, derived from subunit preservative, cell cultures, and antibiotic free, 0.5 mL dosage, for intramuscular use is the recent in influenza codes added to the code set. The code is just out of numerical series, and the placement puts it after the 90661.

The proposed transmittal guides the Medicare administrative contractors to manually add the right code with an effective date of service of the month August 1, 2016 with Type of Service V. v. Influenza virus vaccine code 90674 will be paid by MACs deployed on the lower of the actual charge or 95% of the Average Wholesale Price (AWP) to:

1.                  IHS CAHs submitting claims on TOB 85X
2.                  Indian Health Services (IHS) hospitals submitting claims on TOB 12X and 13X
3.                  Independent Renal Dialysis Facilities using TOB 72X
4.                  Comprehensive Outpatient Rehabilitation Facilities using TOB 75X

Number MM9763 MACs will manage and hold institutional claims with code 90674 with dates of service on or after January 1, 2017, through the day of February 20, 2017, until the Fiscal Intermediary Shared System (FISS) changes are applied and executed on the day of February 20, 2017, in accordance to MLN Matters. Medicare will utilize the CMS Season Influenza pricing webpage to evaluate the payment rate for 90674 as usual.
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It will release further guidance and instructions on how to manage claims for code 90674 with dates of service from August 1, 2017, through December 31, 2016, Medicare says.

Coding Vaccines, a Reminder
In the CPT 2017 Professional, the American Medical Association reminds coders that 90764 merely pay for the vaccine product.  Use codes 90464, 90460, 90471, 90473, 90472, and 90474 to report the administration of a vaccine. Separately report the evaluation and management (E/M) code, if suitable.