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Medicare publishes 2018-2019 influenza vaccine pricing



October 23, 2018
Area(s) of Interest: Public Payors Public Health 

The Center for Medicare and Medicaid Services (CMS) recently published an update on Medicare’s influenza vaccine payment allowances and effective dates for the 2018-2019 flu season.

The Medicare Part B payment allowance limits for seasonal influenza and pneumococcal vaccines are calculated at 95 percent of the average wholesale price.

Payment allowances and effective dates for the 2018-2019 flu season:​

Code Labeler Name Drug Name Payment Allowance Effective Dates
90653 Seqirus Inc Fluad (2018/2019) $54.673 08/01/2018 - 07/31/2019
90656 Seqirus Inc Afluria (2018/2019) $19.773 08/01/2018 - 07/31/2019
90662 Sanofi Pasteur Fluzone High-Dose (2018/2019) $53.373 08/01/2018 - 07/31/2019
90674 Seqirus Inc Flucelvax Quadrivalent (2018/2019) $24.047 08/01/2018 - 07/31/2019
90682 Sanofi Pasteur Flublok Quadrivalent (2018/2019) $53.373 08/01/2018 - 07/31/2019
90685 Sanofi Pasteur Fluzone Quadrivalent Pediatric (2018/2019) $21.813 08/01/2018 - 07/31/2019
90686 Seqirus Inc, GlaxoSmithKline,
Sanofi Pasteur
Afluria Quadrivalent (2018/2019), Fluarix Quadrivalent (2018/2019), Flulaval Quadrivalent (2018/2019), Fluzone Quadrivalent (2018/2019) [Preservative Free] $19.032 08/01/2018 - 07/31/2019
90687 Sanofi Pasteur Fluzone Quadrivalent Pediatric (2018/2019) $9.403 08/01/2018 - 07/31/2019
90688 Seqirus Inc, GlaxoSmithKline,
Sanofi Pasteur
Afluria Quadrivalent (2018/2019), Flulaval Quadrivalent (2018/2019), Fluzone Quadrivalent (2018/2019) $17.835 08/01/2018 - 07/31/2019
90756 Seqirus Inc Flucelvax Quadrivalent (2018/2019) $22.793 08/01/2018 - 07/31/2019
Q2035 Seqirus Inc Afluria (2018/2019) $18.236 08/01/2018 - 07/31/2019
90689 TBD TBD TBD

01/01/2019 - 07/31/2019

A new influenza virus vaccine CPT code (90689: Influenza virus vaccine quadrivalent [IIV4], inactivated, adjuvanted, preservative free, 0.25mL dosage, for intramuscular use) has been approved and will be payable by Medicare beginning with dates of service on or after January 1, 2019. This new code will be included in the 2019 Medicare Physician Fee Schedule Database file update and the annual Healthcare Common Procedure Coding System update. The new influenza virus vaccine code 90689 is not retroactive to August 1, 2018. No claims will be accepted for influenza virus vaccine code 90689 with dates of service between August 1, 2018, and December 31, 2018. The payment allowance for 90689 is not yet available, but will be provided when the product pricing information becomes available to CMS.

More information on 2018-2019 influenza vaccine pricing is available in MM10914 or on CMS website.

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