Influenza and Pneumococcal Vaccines and Administration Reimbursement


The following services are paid at 100 percent of the established fee schedule amount. Coinsurance and the annual deductible do not apply. 

  • Payment allowances for influenza vaccines are effective August 1, 2020, unless stated otherwise
     
  • Influenza and pneumococcal vaccine payment allowances are subject to change on a quarterly basis*
     
  • Administration payment allowances are updated annually on January 1

*Quarterly changes to influenza and pneumococcal vaccine payment allowances can be located on the CMS website.

Influenza, and Pneumococcal Administration Codes and Fees
Following are the 2021 influenza and pneumococcal administration fees for dates of service January 1, 2021 through December 31, 2021.

CPT Codes

Description

NC

 FSY 2021

Amount

SC

FSY 2021

Amount

VA

 FSY 2021

Amount

WV

FSY 2021

Amount

G0008

Admin influenza virus vac.

$16.26

$15.94

$17.01

$15.63

G0009

Admin pneumococcal vaccine

$16.26

$15.94

$17.01

$15.63

Influenza Virus Vaccine National Fees Effective August 1, 2020 – July 31, 2021
The 2020–2021 flu season fees are listed below. Contractors are required to implement these fees no later than October 1, 2020. Palmetto GBA implemented the following fees on September 18, 2020, for dates of service August 1, 2020 and after. All claims processed and paid prior to September 18, 2020 will be automatically adjusted. No further action is required.  

CPT Codes

Description

08/01/20 – 7/31/21

Amount

90630*

Flu vacc iiv4 no preserv id

Pending

90653

Iiv adjuvant vaccine im

 $59.53

90654*

Flu vacc iiv3 no preserv id

Pending

90655*

Iiv3 vacc no prsv 0.25 ml im

Pending

90656*

Iiv3 vacc no prsv 0.5 ml im

Pending

90657*

Iiv3 vaccine splt 0.25 ml im

Pending

90661*

Cciiv3 vac no prsv 0.5 ml im

Pending

90662

Iiv no prsv increased ag im

$60.98

90672

Laiv4 vaccine intranasal

$26.88

90673*

Riv3 vaccine no preserv im

Pending

90674

Cciiv4 vac no prsv 0.5 ml im

$29.23

90682

Riv4 vacc recombinant dna im

$60.98

90685

Iiv4 vacc no prsv 0.25 ml im

$21.13

90686

Iiv4 vacc no prsv 0.5 ml im

$19.58

90687

Iiv4 vaccine splt 0.25 ml im

$9.58

90688

Iiv4 vaccine splt 0.5 ml im

$19.17

90689*

Vacc iiv4 no prsrv 0.25 ml im

Pending

906941

Quadrivalent(aIIV4) inactivated,adjuvanted,pres free,0.5ml

$61.00

90756

Cciiv4 vacc abx free im

$27.70

Q2035*

Afluria vacc, 3 yrs & >, im

 Pending

Q2036*

Flulaval vacc, 3 yrs & >, im

Pending

Please see IMPORTANT footnote below

Q2037*

Fluvirin vacc, 3 yrs & >, im

Pending

Please see IMPORTANT footnote below

Q2038*

Fluzone vacc, 3 yrs & >, im

Pending

 Please see IMPORTANT footnote below

Q2039

Influenza virus vaccine, nos

Specify Drug Name; May Require Invoice

 New code effective July 1, 2020.  
* Important: Please verify coding where a fee is pending. This is usually an indication that there are no sources available to establish a fee. If billing a code with fee pending, you will need to provide a valid NDC for the current 2020–2021 flu season. Your claim will be rejected if incorrectly coded. The following HCPCS code to NDC crosswalk is made available for your reference. Note that some sources listed in this cross-walk represent 2017–2018, 2018–2019 and 2019–2020 flu season vaccines. These resources could be rejected if provided during the current 2020–2021 flu season.This information is also located on the CMS website.

Excerpt from CMS file: Oct 2020 AWP NDC-HCPCS Crosswalk_09022020.xlsx

HCPCS Code

Short Descriptor

Labler Name

NDC

Drug Name

90630

Flu vacc iiv4 no preserv id

Sanofi Pasteur

49281-0712-40

Fluzone Intradermal Quadrivalent (Preservative Free) 2017/2018

90653

Iiv adjuvant vaccine im

Seqirus Inc

70461-0018-03

Fluad (Preservative Free) (2018/2019)

90653

Liv adjuvant vaccine im

Seqirus

70461-0019-03

Fluad (2019/2020)

90653

Liv adjuvant vaccine im

Seqirus Inc

70461-0020-03

Fluad (2020/2021)

90656

IIV3 VACC NO PRSV 0.5 ML IM

Seqirus Inc

33332-0018-01

Afluria (Preservative Free) (2018/2019)

90662

Iiv no prsv increased ag im

Sanofi Pasteur

49281-0403-65

Fluzone High-Dose (Preservative Free) (2018/2019)

90662

Liv no prsv increased

Sanofi Pasteur, Inc.

49281-0405-65

Fluzone High-Dose (2019/2020)

90662

Iiv no prsv increased ag im

Sanofi Pasteur

49281-0403-65

Fluzone High-Dose (2019/2020)

90662

Iiv no prsv increased ag im

Sanofi Pasteur

49281-0120-65

Fluzone High-Dose Quadrivalent (2020/2021)

90672

Laiv4 vaccine intranasal

MedImmune, LLC

66019-0305-10

FluMist Quadrivalent (2018/2019)

90672

Laiv4 vaccine intranasal

MedImmune

66019-0306-10

FluMist Quadrivalent (2019/2020)

90672

Laiv4 vaccine intranasal

MedImmune, LLC

66019-0307-10

FluMist Quadrivalent (2020/2021)

90674

CCIIV4 VAC NO PRSV 0.5 ML IM

Seqirus Inc

70461-0318-03

Flucelvax Quadrivalent (Preservative Free) (2018/2019)

90674

CCIIV4 VAC NO PRSV 0.5 ML IM

Seqirus

70461-0319-03

Flucelvax Quadrivalent (2019/2020) (Pres Free)

90674

CCIIV4 VAC NO PRSV 0.5 ML IM

Seqirus Inc

70461-0320-03

Flucelvax Quadrivalent (2020/2021) (Pres Free)

90682

RIV4 VACC RECOMBINANT DNA IM

Sanofi Pasteur

49281-0718-10

Flublok Quadrivalent (Preservative Free) (2018/2019)

90682

RIV4 VACC RECOMBINANT DNA IM

Sanofi Pasteur, Inc.

49281-0719-10

Flublok Quadrivalent (2019/2020)

90682

RIV4 VACC RECOMBINANT DNA IM

Sanofi Pasteur

49281-0720-10

Flublok Quadrivalent (2020/2021)

90685

IIV4 VACC NO PRSV 0.25 ML IM

Sanofi Pasteur

49281-0518-25

Fluzone Quadrivalent Pediatric (Preservative Free) (2018/2019)

90685

IIV4 VACC NO PRSV 0.25 ML IM

Sanofi Pasteur Inc

49281-0519-25

Fluzone Quadrivalent 0,25ml (2019/2020

90685

IIV4 VACC NO PRSV 0.25 ML IM

Seqirus

33332-0219-20

Afluria Quadrivalent 0.25ml (2019/2020) (Pres Free)

90685

IIV4 VACC NO PRSV 0.25 ML IM

Sanofi Pasteur

49281-0520-25

Fluzone Quadrivalent 0,25ml  (2020/2021) (Pres Free)

90685

IIV4 VACC NO PRSV 0.25 ML IM

Seqirus Inc

33332-0220-20

Afluria Quadrivalent 0.25ml (2020/2021) (Pres Free)

90686

IIV4 VACC NO PRSV 0.5 ML IM

ID Biomedical

33332-0220-20

Afluria Quadrivalent (Preservative Free) 2017/2018

90686

IIV4 VACC NO PRSV 0.5 ML IM

ID Biomedical

58160-0907-52

Fluarix Quadrivalent (Preservative Free) 2017/2018

90686

IIV4 VACC NO PRSV 0.5 ML IM

ID Biomedical

19515-0912-52

Flulaval Quadrivalent (Preservative Free) 2017/2018

90686

IIV4 VACC NO PRSV 0.5 ML IM

ID Biomedical

49281-0417-50

Fluzone Quadrivalent (Preservative Free) 2017/2018

90686

IIV4 VACC NO PRSV 0.5 ML IM

Seqirus Inc

33332-0318-01

Afluria Quadrivalent (Preservative Free) (2018/2019)

90686

IIV4 VACC NO PRSV 0.5 ML IM

GlaxoSmithKline

58160-0898-52

Fluarix Quadrivalent (Preservative Free) (2018/2019)

90686

IIV4 VACC NO PRSV 0.5 ML IM

GlaxoSmithKline

19515-0909-52

Flulaval Quadrivalent (Preservative Free) (2018/2019)

90686

IIV4 VACC NO PRSV 0.5 ML IM

Sanofi Pasteur

49281-0418-50

Fluzone Quadrivalent (Preservative Free) (2018/2019)

90686

IIV4 VACC NO PRSV 0.5 ML IM

Sanofi Pasteur

49281-0418-10

Fluzone Quadrivalent (Preservative Free) (2018/2019)

90686

IIV4 VACC NO PRSV 0.5 ML IM

GlaxoSmithKline

58160-0896-52

Fluarix Quadrivalent (2019/2020) (Pres free)

90686

IIV4 VACC NO PRSV 0.5 ML IM

GlaxoSmithKline

19515-0906-52

Flulaval Quadrivalent (2019/2020) (Pres Free)

90686

IIV4 VACC NO PRSV 0.5 ML IM

Sanofi Pasteur, Inc.

49281-0419-50

Fluzone Quadrivalent (2019/2020) (Pres Free)

90686

IIV4 VACC NO PRSV 0.5 ML IM

Sanofi Pasteur, Inc.

49281-0419-10

Fluzone Quadrivalent (2019/2020) (Pres Free)

90686

IIV4 VACC NO PRSV 0.5 ML IM

Seqirus

33332-0319-01

Afluria Quadrivalent (2019/2020) (Pres Free)

90686

IIV4 VACC NO PRSV 0.5 ML IM

GlaxoSmithKline

58160-0885-52

Fluarix Quadrivalent (2020/2021) (Pres free)

90686

IIV4 VACC NO PRSV 0.5 ML IM

GlaxoSmithKline

19515-0816-52

Flulaval Quadrivalent (20202021) (Pres Free)

90686

IIV4 VACC NO PRSV 0.5 ML IM

Sanofi Pasteur

49281-0420-50

Fluzone Quadrivalent (2020/2021) (Pres Free)

90686

IIV4 VACC NO PRSV 0.5 ML IM

Sanofi Pasteur

49281-0420-10

Fluzone Quadrivalent (2020/2021) (Pres Free)

90686

IIV4 VACC NO PRSV 0.5 ML IM

Seqirus Inc

33332-0320-01

Afluria Quadrivalent (2020/2021) (Pres Free)

90687

IIV4 VACCINE SPLT 0.25 ML IM

Sanofi Pasteur

49281-0629-15

Fluzone Quadrivalent (2018/2019)

90687

IIV4 VACCINE SPLT 0.25 ML IM

Sanofi Pasteur, Inc.

49281-0631-15

Fluzone Quadrivalent 0.25ml (2019/2020)

90687

IIV4 VACCINE SPLT 0.25 ML IM

Seqirus

3332-0419-10

Afluria Quadrivalent 0.25ml (2019/2020)

90687

IIV4 VACCINE SPLT 0.25 ML IM

Sanofi Pasteur

49281-0633-15

Fluzone Quadrivalent 0.25ml (2020/2021)

90687

IIV4 VACCINE SPLT 0.25 ML IM

Seqirus Inc

33332-0420-10

Afluria Quadrivalent 0.25ml (2020/2021)

90688

IIV4 VACCINE SPLT 0.5 ML IM

Seqirus Inc

33332-0418-10

Afluria Quadrivalent (2018/2019)

90688

IIV4 VACCINE SPLT 0.5 ML IM

GlaxoSmithKline

19515-0900-11

Flulaval Quadrivalent (2018/2019)

90688

IIV4 VACCINE SPLT 0.5 ML IM

Sanofi Pasteur

49281-0629-15

Fluzone Quadrivalent (2018/2019)

90688

IIV4 VACCINE SPLT 0.5 ML IM

GlaxoSmithKline

19515-0897-11

Flulaval Quadrivalent (2019/2020)

90688

IIV4 VACCINE SPLT 0.5 ML IM

Sanofi Pasteur, Inc.

49281-0631-15

Fluzone Quadrivalent (2019/2020)

90688

IIV4 VACCINE SPLT 0.5 ML IM

Seqirus

33332-0419-10

Afluria Quadrivalent (2019/2020)

90688

IIV4 VACCINE SPLT 0.5 ML IM

Sanofi Pasteur

49281-0633-15

Fluzone Quadrivalent (2020/2021)

90688

IIV4 VACCINE SPLT 0.5 ML IM

Seqirus Inc

33332-0420-10

Afluria Quadrivalent (2020/2021)

90694

VACC AIIV4 NO PRSRV 0.5ML IM

Seqirus Inc

70461-0120-03

Fluad Quadrivalent (2020/2021)

90756

CCIIV4 VACC ABX FREE IM

Seqirus Inc

70461-0418-10

Flucelvax Quadrivalent (2018/2019)

90756

CCIIV4 VACC ABX FREE IM

Seqirus

70461-0419-10

Flucelvax Quadrivalent (2019/2020)

90756

CCIIV4 VACC ABX FREE IM

Seqirus Inc

70461-0420-10

Flucelvax Quadrivalent (2020/2021)

Q2035

Afluria vacc, 3 yrs & >, im

Seqirus Inc

33332-0118-10

Afluria (2018/2

Disclaimer: The above list may not be all-inclusive. Please be sure you are providing vaccines appropriate for the current 2020/2021 flu season.

Pneumococcal Vaccine National Fees 
The fees provided below are subject to change with each quarterly drug update. For current fees, please check the CMS website at the following URL.

CPT
Codes

Description

1/01/21

04/01/21

07/01/21

10/01/21

90670

Pneumococcal vacc, 13 val im

$230.14

$241.38

 

 

90732

Pneumococcal vaccine 

$119.92

   $125.92

 

 

Reference Documents

  • CR12020 January 2021 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files
  • CR12133 April 2021 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files
  • CR 11882 - Influenza Vaccine Payment Allowances – Annual Update for 2020-2021 Season
  • Seasonal Influenza Vaccines Pricing




Last Updated: 04/23/2021