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