July 14, 2014

Gastrostomy Tube Placement CPT Procedure, ICD 9/10 Codes

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Learn all about Gastrostomy Tube Placement interventional radiology CPT Procedure Codes and ICD 9/10 Codes.

Some patients are not able to take food by mouth or cannot swallow properly. They may have some congenital abnormalities of mouth, esophagus, stomach, or intestines. Physician inserts G-tube in those patients so that they can take adequate nutrition by mouth.

However, some patients (mostly children) are unable to tolerate feeding of food directly into the stomach. The G-tube is required to be converted into GJ tube in these cases. This article covers all the ICD Codes and CPT Codes required for the medical billing of this conversion procedure under fluoroscopic guidance.

Gastrostomy Tube Placement CPT Procedure, ICD 9/10 Codes

There are some adult patient, who cannot take enough food through mouth or have swallowing food problems, such patients has to go through Gastrostomy Tube Placement.

Gastrostomy Tube Placement Procedures

The patient is placed supine on the procedure table and prepped and draped sterilely. The physician places a tube through the skin and into the stomach and uses x-rays to make sure it is in the right place.

Contrast dye is injected into the tube and fluoroscopic imaging technique is performed to confirm proper placement and to make sure that contrast
travels freely through the tube freely, without any obstruction.

Gastrostomy Tube (G-Tube) Procedure

This is a tube inserted into the stomach through a small incision in the abdomen. The tube goes through the skin (percutaneous) to the stomach wall and then into the stomach. This tube feeding into the stomach is called gastrostomy tube (G-Tube).

Gastro Jejunostomy Tube (GJ-Tube) Procedure

This is a feeding tube which is inserted through the gastrostomy stoma in the abdominal wall, passes through the stomach and advances into the jejunum. This tube feeding directly into the intestines is called Gastrojejunostomy tube (GJ-Tube).

Documentation of the image produced by the fluoroscopic guided imaging technique and report are included in this CPT.

Gastrostomy Tube Placement CPT Codes

The most common Percutaneous Gastrostomy Tube Placement CPT codes used for the insertion of tube in stomach region are given below:
  • 49440 Insertion of gastrostomy tube, percutaneous, under fluoroscopic guidance including contrast injection(s), image documentation and report.
  • 49441 Insertion of duodenostomy or jejunostomy tube, percutaneous, under fluoroscopic guidance including contrast injection(s), image documentation and report.
  • 49442 Insertion of cecostomy or other colonic tube, percutaneous, under fluoroscopic guidance including contrast injection(s), image documentation and report.

Gastrostomy Tube Placement ICD 9/10 Codes

Find below the list of the common ICD 9 diagnosis codes with their ICD 10cm conversion codes; used for Percutaneous Gastrostomy Tube Placement:
  1. 530.11 Reflux Esophagitis (ICD 9)
    K21.0 Gastro-esophageal reflux disease with esophagitis (ICD 10)

  2. 530.12 Acute Esophagitis (ICD 9)
    K20.9 Esophagitis, unspecified (ICD 10)

  3. 530.19 Other Esophagitis (ICD 9)
    K20.8 Other Esophagitis (ICD 10)

  4. 530.20 Ulcer of Esophagus without bleeding (ICD 9)
    K22.10 Ulcer of Esophagus without bleeding (ICD 10)

  5. 530.21 Ulcer of Esophagus with bleeding (ICD 9)
    K22.11 Ulcer of Esophagus with bleeding (ICD 10)

  6. 530.3 Stricture and stenosis of esophagus (ICD 9)
    K22.2 Esophageal Obstruction (ICD 10)

  7. 530.4 Perforation of Esophagus (ICD 9)
    K22.3 Perforation of Esophagus (ICD 10)

  8. 530.5 Dyskinesia of Esophagus (ICD 9)
    K22.4 Dyskinesia of Esophagus (ICD 10)

  9. 530.6 Diverticulum of Esophagus, acquired (ICD 9)
    K22.5 Diverticulum of Esophagus, acquired (ICD 10)

  10. 530.7 Gastro Esophageal Laceration Hemorrhage Syndrome (ICD 9)
    K22.6 Gastro Esophageal Laceration Hemorrhage Syndrome (ICD 10)

  11. 530.81 Esophageal Reflux (ICD 9)
    K21.9 Gastro-Esophageal Reflux Disease without Esophagitis (ICD 10)

  12. 530.82 Esophageal Hemorrhage (ICD 9)
    K22.8 Other Specified Diseases of Esophagus (ICD 10)

  13. 530.83 Esophageal Leukoplakia (ICD 9)
    K22.8 Other Specified Diseases of Esophagus (ICD 10)

  14. 530.84 Tracheoesophageal Fistula (ICD 9)
    J86.0 Pyothorax with Fistula (ICD 10)

  15. 530.85 Barrett's Esophagus (ICD 9)
    K22.70 Barrett's Esophagus without Dysplasia (ICD 10)

  16. 530.89 Other specified disorder of the esophagus (ICD 9)
    K22.8 Other specified diseases of esophagus (ICD 10)

  17. 536.8 Dyspepsia and other specified disorders of function of stomach (ICD 9)
    K30 Functional dyspepsia (ICD 10)

  18. 787.20 Dysphagia, unspecified (ICD 9)
    R13.10 Dysphagia, unspecified (ICD 10)

  19. 787.21 Dysphagia, oral phase (ICD 9)
    R13.11 Dysphagia, oral phase (ICD 10)

  20. 787.22 Dysphagia, oropharyngeal phase (ICD 9)
    R13.12 Dysphagia, oropharyngeal phase (ICD 10)

  21. 787.23 Dysphagia, pharyngeal phase (ICD 9)
    R13.13 Dysphagia, pharyngeal phase (ICD 10)

  22. 787.24 Dysphagia, pharyngoesophageal phase (ICD 9)
    R13.14 Dysphagia, pharyngoesophageal phase (ICD 10)

  23. 787.29 Other dysphagia (ICD 9)
    R13.19 Other dysphagia (ICD 10)
Hope, this article help you in the medical billing and coding of Gastrostomy Tube Placement by learning the CPT procedure codes and ICD 9, ICD 10 diagnosis codes.

July 7, 2014

ICD 10 Codes for Autism and Autistic Spectrum Disorder

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Autism spectrum disorder and autism are terms used to refer to complication in the development of the brain, beginning in childhood.

The disorders are normally characterized by the difficulties in social interaction, verbal and nonverbal communication. Autism symptoms includes
presence of markedly abnormal or impaired development in social interaction and communication and a markedly restricted repertoire of activity and interest.

Children with autism might have problems talking with you, or they might not look you in the eye when you talk to them. They may spend a lot of time putting things in order before they can pay attention, or they may say the same sentence again and again to calm themselves down. They often seem to be in their "own world."because people with autism can have very different features or symptoms, health care providers think of autism as a "spectrum" disorder.

Manifestations of the Autistic disorder vary greatly depending on the developmental level and chronological age of the individual. The Autistic spectrum disorder is associated with difficulties in motor coordination, as well as physical health issues associated with sleep and gastrointestinal disturbance.

ICD 10 Codes for Autism and Autistic Spectrum Disorder

Statistics in the U.S indicate that 1 in 68 American children suffer from the condition. There is tenfold increase in Autistic children for the past 40 years, mostly prevalent in boys than girls.

The exact cause of autism is not known but the main reason of this common type of mental condition is gene mutation, as well as environmental factors that influence early brain development. Some of the other risk factors include parental age at the time of conception, maternal illness or difficulties during birth.

Autism lasts throughout a person's lifetime. There is no cure, but treatment can help. Treatments include behavior and communication therapies and medicines to control symptoms. Starting treatment as early as possible is important.

Autism and Autistic Spectrum Disorders ICD 10 Codes

Below are some of the most common Autism and Autistic Spectrum Disorder's ICD 10cm Codes that will be required for Medical Coding and Billing after ICD 10 Implementation:

F84.0 Childhood Autism

A type of pervasive developmental disorder that is defined by:
(a) The presence of abnormal or impaired development that is manifest before the age of three years, and (b) the characteristic type of abnormal functioning in all the three areas of psychopathology: reciprocal social interaction, communication, and restricted, stereotyped, repetitive behavior. In addition to these specific diagnostic features, a range of other nonspecific problems are common, such as phobias, sleeping and eating disturbances, temper tantrums, and (self-directed) aggression.

F84.1 A typical Autism

A type of pervasive developmental disorder that differs from childhood autism either in age of onset or in failing to fulfil all three sets of diagnostic criteria. This subcategory should be used when there is abnormal and impaired development that is present only after age three years, and a lack of sufficient demonstrable abnormalities in one or two of the three areas of psychopathology required for the diagnosis of autism (namely, reciprocal social interactions, communication, and restricted, stereotyped, repetitive behavior) in spite of characteristic abnormalities in the other area(s). Atypical autism arises most often in profoundly retarded individuals and in individuals with a severe specific developmental disorder of receptive language.

299.00 Autistic Disorder

ICD-10 code 299.00 is used to define autistic disorder with various characteristic. The code further characterizes autistic disorder into:

A total of six (or more) items from (1), (2) and (3), with at least two from (1), and one each from (2) and (3):
  1. Qualitative Impairment in Social Interaction as manifested by at least two of the following:
    1. Marked impairment in the use of multiple nonverbal behaviours such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction.
    2. Failure to develop peer relationships appropriate to developmental level.
    3. A lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g., by a lack of showing, bringing, or pointing out objects of interest).
    4. Lack of social or emotional reciprocity.
  2. Qualitative Impairments in Communication as manifested by at least one of the following:
    1. Delay in, or total lack of, the development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gestures or mime).
    2. In individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others.
    3. Stereotyped and repetitive use of language or idiosyncratic language.
    4. Lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level.
  3. Restricted Repetitive and Stereotyped Patterns of Behaviour, Interests and Activities as manifested by at least one of the following:
    1. Encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus.
    2. Apparently inflexible adherence to specific, non-functional routines or rituals.
    3. Stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole body movements).
    4. Persistent preoccupation with parts of objects.
Delays or abnormal functioning in at least one of the following areas, with onset prior to age 3 years:
(1) social interaction, (2) language as used in social communication or (3) symbolic or imaginative play

The disturbance is not better accounted for by Rett’s Disorder or Childhood Disintegrative Disorder.

June 22, 2014

ICD 9 Codes: Pregnancy Screening and Complications

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Codes for complications of pregnancy, childbirth, and the puerperium appear in Chapter 11 in ICD-9-CM. They move to Chapter 15 in ICD-10-CM. In ICD-9-CM, you often need a fifth character to denote whether the mother gave birth during the encounter. For example, if a patient is diagnosed with transient hypertension in pregnancy, you would report 642.3x. The fifth digit denotes:

0, unspecified as to episode of care or not applicable
1, delivered, with or without mention of antepartum condition
2, delivered, with mention of postpartum complication
3, antepartum condition or complication
4, postpartum condition or Complication

Depending on the demographics of the region a hospital serves, its coders could determine code assignment for hundreds of deliveries and pregnancy-related services annually. Therefore, reviewing the related coding guidelines is helpful. Coders must remember that pregnancy is a disease process separate from other disease processes that patients may experience. A pregnancy diagnosis is always reported first, she says. This may seem counterintuitive to coders trained to report the principal diagnosis as the condition after study that is chiefly responsible for admission.

ICD 9 Codes: Pregnancy Screening and Complications

Pregnancy Screening and Complications ICD 9 Diagnosis Codes

Current guidelines indicate that ICD-9-CM code 648.21 is the principal diagnosis for a woman with a pregnancy complicated by anemia who undergoes a cesarean delivery due to fetal distress not present at admission.

Decreased Fetal Movement

Decreased fetal movement (655.7x)—a condition in which a mother cannot feel the fetus move—can be an early sign of a problematic pregnancy. ¬Physicians often document this term before administration and interpretation of a fetal non-stress test that indicates normal development.

The following documentation is necessary to help ¬determine whether decreased fetal movement is present:
  • Was the fetus stressed during the fetal non-stress test?
  • How many heartbeats per minute, including accelerations and decelerations, did the fetus have during the test? Is this normal?
  • How many contractions occurred during the test?
  • What was the patient's blood pressure during the test?
  • Was the patient hydrated or dehydrated during the test?

Fetal Conditions and Management of Mothers

Coders should assign codes from the following categories only when the fetal condition is responsible for modifying management of a mother:

655, known or suspected fetal abnormality affecting management of the mother
656, other known or suspected fetal and placental problems affecting management of the mother

For example, report fetal conditions that require termination of a pregnancy, diagnostic ¬studies, additional observation, or special care. The mere existence of a fetal condition does not justify assigning a code for that condition, according to the guidelines.

Abortions

The term abortion has a legal connotation, but several more specific terms are also associated with this diagnosis, says Webb. These include the following:
  • Spontaneous abortion, including miscarriage (634.x)
  • Legally induced abortion (635.x)
  • Illegally induced abortion (636.x)
  • Unspecified abortion, including retained products of conception following abortion, not classified elsewhere (637.x)
  • Failed attempted abortion (638.x)

Intrapartum Care

Coders often forget to report codes for ¬complications that occur during labor and delivery (codes 660-669), says Webb. For example, when a delivery trauma, such as an episiotomy (73.6), occurs, ¬coders often forget to report a code for cervical laceration (655.3x).

June 15, 2014

ICD 9 Codes for Depression, Anxiety w/o Insomnia, Fatigue etc

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View ICD 9-cm codes for COPD Exacerbation, Asthma, Bronchitis, Emphysema. Chronic obstructive pulmonary disease (COPD) is one of the most common lung diseases.

Some people’s depression is attributed to physical illness while other develop physical symptoms because of being depressed. It is estimated that about 5% to 13% of patients in primary care suffer from major depression

We have also been writing about all types of ICD 10 CM Codes for Hypertension, ICD 9 Code for Hypertension (HTN) from 401 to 405, ICD-10 Codes for Depression and ICD 10 Codes for Mental Disorders.

ICD 9 Codes for Depression, Anxiety w/o Insomnia, Fatigue and Psychotic Features

Depression is a type of mood disorder that is characterized by a persistent feeling of sadness or loss of interest. Major depressive disorder or clinical depression affects how one feels, think and behave and is known to lead to a variety of emotional and physical problems. People suffering from depression find it extremely impossible to carry out normal day to day activities known to make many people feel not worth living.

ICD 9 Codes for Depression/Anxiety

Multiple diagnosis codes exist for coding for depression. The most general is 311, Depressive Disorder, not elsewhere Classified. Code 290.21 represents senile dementia with depressive features. Several codes can be used for reporting acute depression, including 296.2, Major depressive disorder, single episode. ICD 9cm code 296.3 is used for Major depressive disorder, recurrent episode. (Note that both of these codes require a fifth digit)

ICD 9 Code 300.4 Neurotic depression also referred to as "reactional depression" can be used to code depression brought on by personal change or unexpected circumstances. This type of depression can become chronic unless treated, and the affected individual is able to function normally.

In comparison, Situational Depression, which is transient and tends to impair an individual’s ability to function more significantly than neurotic depression, may be coded as 309.0 (brief) or 309.1 (prolonged).

Maternity-related depression should be coded using 648.4 A fifth digit is required to denote the current episode of care. For example, Postpartum Depression would be coded as 648.44.

When a definitive diagnosis of depression is not or cannot be made, the patient’s presenting symptoms should be coded instead. For example, if a patient presents complaining of fatigue and malaise, you could code the visit using 780.79, Depression with Malaise and Fatigue.

Depression Medical Billing

Unfortunately, some family physicians are tempted to code a patient’s symptoms, even in the face of a definitive diagnosis. They may do so to avoid conflict with the patient, ensure insurance coverage or to help the patient avoid the larger copays/ coinsurances sometimes associated with mental health care.

While such "Creative Coding" is well intended, it is not recommended as standard Medical Billing Coding practice. It exposes physicians to potential fraud and abuse liability. It also obscures the reported incidence of depression in the primary care setting and contributes to the perception in some circles that family physicians are not capable of diagnosing and treating depression. Above all, it stand contrary to the Correct Coding principles.

Family physicians may diagnose and treat depression in the context of evaluation and management (E/M) services. Depression may be secondary to another diagnosis or it may be a primary diagnosis if the patient presents with symptoms that lead to a depression diagnosis or if depression has previously been diagnosed and is the reason for the patient’s visit.

Coding for the diagnosis and treatment of depression is fraught with peril. Some patients may not like the diagnosis and some payers may not cover the service. However, if those obstacles can be overcome, diagnosis and treatment of depression can pay as well as the diagnosis and treatment of other conditions commonly seen in family medicine.

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June 2, 2014

COPD ICD 9CM Codes: Exacerbation, Asthma, Bronchitis, Emphysema

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View ICD 9-cm codes for COPD Exacerbation, Asthma, Bronchitis, Emphysema. Chronic obstructive pulmonary disease (COPD) is one of the most common lung diseases.

Chronic obstructive pulmonary disease is a chronic bronchitis alpha-1 antitrypsin deficiency that is a genetic form of emphysema. The disease is most of the time characterized by the narrowing or obstruction of airflow and interference that hinders normal breathing. The primary risk factor for chronic obstructive pulmonary disease is smoking or second hand smoking, heredity and air pollution.

COPD ICD 9CM Codes: Exacerbation, Asthma, Bronchitis, Emphysema

COPD with Acute Bronchitis ICD 9CM Codes

A diagnosis of COPD and acute bronchitis is classified to code 491.22. It is not necessary to assign code 466.0 (acute bronchitis) with 491.22. Code 491.22 is also assigned if the physician documents acute bronchitis with COPD exacerbation. However, if acute bronchitis is not mentioned with the COPD exacerbation, then code 491.21 is assigned (AHA Coding Clinic for ICD-9-CM, 2008, fourth quarter, pages 241-244).

ICD 9CM Code for COPD with Asthma

Asthma with COPD is classified to code 493.2x. However, all coding directives in the Tabular List and index need to be reviewed to ensure appropriate code assignment. A fifth-digit sub classification is needed to identify the presence of status asthmaticus or exacerbation.

COPD with Exacerbation

Exacerbation is defined as a decompensation of a chronic condition. It is also defined as an increased severity of asthma symptoms, such as wheezing and shortness of breath. Although an infection can trigger it, an exacerbation is not the same as an infection superimposed on a chronic condition. Status asthmaticus is a continuous obstructive asthmatic state unrelieved after initial therapy measures.

If a physician documents both exacerbation and status asthmaticus on the same record, only assign the fifth digit "1" to show the status asthmaticus. Sequence the status asthmaticus code first if documented with any type of COPD or with acute bronchitis (AHA Coding Clinic for ICD-9-CM, 2008, fourth quarter, pages 241-244).

COPD with exacerbation is classified to code 491.21, which also includes the following:
  • Acute Exacerbation of COPD
  • Exacerbation of COPD
  • Decompensated COPD
  • Decompensated COPD with Exacerbation
  • COPD in Exacerbation
  • Severe COPD in exacerbation
  • End-stage COPD in exacerbation
The word Acute need not be documented to assign code 491.21 for exacerbation of COPD (AHA Coding Clinic for ICD-9-CM, 2002, third quarter, page 18).

When the acute exacerbation of COPD is clearly identified, it is the condition that will be designated as the principal diagnosis. (AHA Coding Clinic for ICD-9-CM, 1988, third quarter, pages 5-6).

According to current coding advice, acute exacerbation of COPD, acute bronchitis, and acute exacerbation of asthma is classified to codes 491.22 and 493.22 (AHA Coding Clinic for ICD-9-CM, 2006, third quarter, page 20).

Coding and sequencing for COPD are dependent on the physician documentation in the medical record and application of the Official Coding Guidelines for inpatient care.

COPD Diagnosis and Treatment

After diagnosis, the most important and effective treatment for COPD is smoking cessation. The benefits of quitting smoking apply regardless of age, amount smoked, or severity of COPD.

In addition to medications, patients may require home oxygen, pulmonary rehab to improve overall quality of life and, in severe cases, surgery such as a lung transplant or lung volume reduction, during which the physician removes small wedges of damaged tissue.

May 25, 2014

Flu Shot CPT/HCPCS, ICD Codes with Medicare Allowables

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Learn CPT Codes used for Medicare billing of Influenza Vaccines, commonly known as Flu Shots. You can also check out our article on Influenza/Pneumococcal Billing & Reimbursement in 2011.

Influenza (flu), is a contagious respiratory illness caused by influenza viruses. There are over 200,000 hospitalizations from influenza annually. An average of 36,000 Americans die annually due to influenza and its complications, most are people 65 years of age and over. The best way to prevent the flu is to get vaccinated each year during the fall season.

Centers for Medicare & Medicaid Services (CMS) no longer recognize and reimburse CPT Code 90658 Influenza Virus Vaccine, Split Virus for flu shots. CMS has established five separate influenza vaccine HCPCS codes to distinguish between the brand-names of influenza vaccines for governmental tracking purposes. Make sure to use these new codes in your medical billing.

EMR/EHR System Implementation Process

The flu season extends from September to March. Seasonal flu vaccination should begin as soon as vaccine is available (usually early September) and continue throughout the flu season. Seasonal flu outbreaks can happen as early as October, and seasonal flu activity usually peaks during the winter. Most types of injections, including a vaccine like the flu shot, are billed using two codes:

Part One: A code for the flu vaccine itself, whether it is a liquid to be injected, or a mist that is to be inhaled.
Part Two: A code for the administration of the injection BILLING FOR FLU SHOTS - BASICS

Who should be vaccinated

Although it’s true that the vaccine does not protect 100% of those who get it, it does protect most from life-threatening illness. The advisory committee on immunization practices (ACIP) recommends universal seasonal flu vaccination for anyone age 6 months and older.
  1. It includes age 6 months through 4 years (59 months).
  2. Older than 50 years with chronic pulmonary (including asthma), cardiovascular (except hypertension), renal, hepatic, neurologic, hematologic or metabolic disorders (including diabetes mellitus).
  3. Pregnant women who are Immunosuppressed (including immunosuppression caused by medications or by human immunodeficiency virus)
  4. Age 6 months through 18 years using long-term aspirin therapy and who might be at risk for experiencing REYE SYNDROME after flu virus infection.
  5. Residents of nursing homes and other chronic care.
  6. American Indian/Alaska Natives
  7. Those who are morbidly obese

Flu Shot ICD Codes for Diagnoses

Use ICD 9 diagnosis code V04.81 Prophylactic vaccination and inoculation against influenza. If you are giving Pneumococcus and Influenza vaccinations on the same date, use ICD code V06.6. When giving a vaccination at the same time as seeing a patient for a medically necessary office visit, use a modifier 25 on the E/M code and map the E/M to a diagnosis code that describes the reason for the visit.

New HCPCS Medicare Flu Shot Codes

HCPCS Code G0008 Administration of Influenza Virus Vaccine must still be used for the administration of the flu vaccine for Medicare patients. Below are the most commonly used Medicare Flu Shots CPT Codes:
  • Q2035 Afluria Vaccine
    Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Afluria)

  • Q2036 Flulaval Vaccine
    Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Flulaval)

  • Q2037 Fluvirin Vaccine
    Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Fluvirin)

  • Q2038 Fluzone Vaccine
    Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Fluzone)

  • Q2039 NOS (Not Otherwise Specified) Vaccine
    Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Not Otherwise Specified)

Medicare Allowable CPT/HCPCS Brand

Some payers do not recognize the value of the administration of any vaccine, and will not pay a separate amount for administration, however, most payers, including Medicare, will reimburse for both the vaccine itself and the administration. Below are the CPT/HCPCS brand with their Medicare allowables against them for Medicare Flu Shots Reimbursement:
  • 90654 Fluzone ($18.918)
  • 90655 Fluzone ($17.243 )
  • 90656 Afluria, Fluarix, Fluvirin, Fluzone ($12.398)
  • 90657 Fluzone ($6.022 )
  • 90658 Afluria, FluLavil, Fluvirin, Fluzone (See Q-codes below)
  • 90661 Flucelvax (20.663)
  • 90662 Fluzone ($31.823)
  • 90672 FluMist ($24.596)
  • 90673 FluBlok (Pending)
  • 90685 Fluzone ($23.228)
  • 90686 Fluarix, Fluzone ($19.409)
  • 90687 Pending (Pending)
  • 90688 FluLaval (Pending)
  • Q2033 Medicare: FluBlok (Pending)
  • Q2035 Medicare: Afluria ($11.543)
  • Q2036 Medicare: FluLaval ($8.579)
  • Q2037 Medicare: Fluvirin ($14.963)
  • Q2038 Medicare: Fluzone ($12.044)
  • Q2039 Medicare: Adult, not otherwise specified (locally determined)
The national average for Medicare payment allowance may vary by geographical location and you will need to check the CMS Fee Schedule for your correct reimbursement rate. The HCPCS codes Q2035 & Q2039 do not have national payment limits and will be determined by the local Medicare carrier.