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What makes a good CPC Practice Exam? Questions and Answers with Full Rationale

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2018 CPC Practice Exam Answer Key 150 Questions With Full Rationale (HCPCS, ICD-9-CM, ICD-10, CPT Codes) Click here for more sample CPC practice exam questions with Full Rationale Answers

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2020-2021 Influenza Vaccine Codes, Pricing, and Recommendations

With the novel coronavirus continuing to circulate and cause severe illness in the United States and worldwide, getting a flu vaccine is more important than ever. The 2020–21 influenza season will coincide with the continued circulation of coronavirus, so start planning now. Common signs and symptoms of COVID-19 (e.g., fever, cough, and dyspnea) can also […]

The post 2020-2021 Influenza Vaccine Codes, Pricing, and Recommendations appeared first on AAPC Knowledge Center.

AAPC Knowledge Center

Code Change for Influenza Season 2020-2021

The 2019-2020 influenza season is winding down, so now is a good time to start preparing for the 2020-2021 influenza season. Let’s start with a new CPT® code for the flu vaccine. Flu Activity Report The Centers for Disease Control and Prevention (CDC) reports that viral activity is decreasing in the United States. According to […]

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AAPC Knowledge Center

2019-2020 Influenza Vaccine Codes and Pricing

With schools and colleges back in session, you can only hope patients start coming in for their influenza vaccine, so communities can keep the spread of seasonal flu to a minimum this year. Healthcare providers should prepare for the flux of injections by updating their billing systems with the 2019 Average Sales Price (ASP) Drug […]

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AAPC Knowledge Center

Correct Influenza Diagnosis Coding

Does anyone have a concrete answer on how to correctly code for confirmed Influenza diagnosis? Our providers are only documenting Influenza A or B positive. They don’t go beyond that specificity. We have conflicting answers from multiple resources. One telling us we should be using J10.1 and another telling us to use J11.1 as they state Influenza A is unidentified. To me The Influenza is identified as A or B, but not elsewhere classified (J10.1) and the description under this code seems to fit. I’m hoping someone can provide someone insight on this coding conundrum. 😀 Thank you!

Medical Billing and Coding Forum

New CPT code 90756 for Influenza vaccine 2018


Effective for claims processed with dates of service (DOS) on or after January 1, 2018, influenza virus vaccine code 90756 (Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, antibiotic free, 0.5mL dosage, for intramuscular use) will be payable by Medicare. This new code will be included on the 2018 Medicare Physician Fee Schedule Database file update and the annual Healthcare Common Procedure Coding System (HCPCS) update.

New Vaccine Code 90756 Description

Long Description: Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, antibiotic free, 0.5mL dosage, for intramuscular use 

Short Description: CCIIV4 VACC ABX FREE IM

Medium Description: CCIIV4 VACCINE ANTIBIOTIC FREE 0.5 ML DOS IM USE Long

Type Of Service Code: V

During the interim period of August 1, 2017, through December 31, 2017, MACs will use code Q2039 (Influenza virus vaccine, not otherwise specified) to handle bills for this new influenza virus vaccine product (Influenza virus vaccine, quadrivalent (ccIIV4).

The new influenza virus vaccine code (90756) is not retroactive to August 1, 2017. Claims will not be accepted for influenza virus vaccine code 90756 between the DOS August 1, 2017, and December 31, 2017. If claims are received in January 2018 with code 90756 for DOS between August 1, 2017, and December 31, 2017, claims will be rejected or returned as unprocessable.


Coding Ahead

High dose Influenza vaccination

A high dose flu shot was given to a pt who is under 65 years old due to the patient is immunocompromised. Insurance has denied it as not eligible due to the patient’s age. Would this be appealable or they would be denied regardless? Does anyone have came across the same issue? Any feedback would help! Thank you!

Medical Billing and Coding Forum

Seasonal Influenza Vaccines Pricing (2017-2018 Flu Season)


CPT 90630 Payment allowance is $ 20.343. Effective dates: 8/1/2017-7/31/2018

CPT 90653 Payment allowance is $ 50.217. Effective dates: 8/1/2017-7/31/2018

CPT 90656 Payment allowance is $ 19.247. Effective dates: 8/1/2017-7/31/2018

CPT 90662 Payment allowance is $ 49.025. Effective dates: 8/1/2017-7/31/2018

CPT 90673 Payment allowance is $ 40.613. Effective dates: 8/1/2017-7/31/2018

CPT 90674 Payment allowance is $ 24.047. Effective dates: 8/1/2017-7/31/2018

CPT 90682 Payment allowance is $ 46.313. Effective dates: 8/1/2017-7/31/2018 (New code)

CPT 90685 Payment allowance is $ 21.198. Effective dates: 8/1/2017-7/31/2018

CPT 90686 Payment allowance is $ 19.032. Effective dates: 8/1/2017-7/31/2018

CPT 90687 Payment allowance is $ 9.403.  Effective dates: 8/1/2017-7/31/2018

CPT 90688 Payment allowance is $ 17.835. Effective dates: 8/1/2017-7/31/2018

CPT 90756 Payment allowance is $ 22.793. Effective dates: 1/1/2018-7/31/2018  (Note: Providers and Medicare Administrative Contractors shall use HCPCS Q2039 for dates of service from 8/1/2017 – 12/31/2017. See special note under HCPCS Q2039 for payment amounts for this product prior to 1/1/2018.)

HCPCS Q2035 Payment allowance is $ 17.685. Effective dates: 8/1/2017-7/31/2018

HCPCS Q2037 Payment allowance is $ 17.685. Effective dates: 8/1/2017-7/31/2018

HCPCS Q2039 Flu Vaccine Adult – Not Otherwise Classified payment allowance is to be determined by the local claims processing contractor with effective dates of 8/1/2017-7/31/2018.

Special note: Until CPT code 90756 is implemented on 1/1/2018; Q2039 shall be used for products described by the following language: influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, antibiotic free, 0.5mL dosage, for intramuscular use. The payment allowance for these products, effective for dates of service 8/1/2017 – 12/31/2017 is $ 22.793.

For more information refer: MM10224

See also: Payment Allowances and Effective Dates for the 2016-2017 Flu Season


Coding Ahead