Influenza, Pneumococcal Billing & Reimbursement

When the same type of vaccine is administered to fewer than 5 Medicare beneficiaries on the same day, you must submit the claim(s) individually via the 'Home Health' Option 26 from the Claims Entry Menu.

The influenza virus vaccine and pneumococcal pneumonia vaccination (PPV) are billed on a 341 type of bill (home health outpatient Part B benefit).

The beneficiary must be eligible for Medicare Part B to receive reimbursement for these services.

• Children, ages 6-35 months
  90655 - Influenza virus vaccine, split virus, preservative free, when administered to children 6-35 months of age, for intramuscular use
• Children, ages 0 months through age 18.99
  90660 – Influenza virus vaccine, live, for intranasal use
  90670* - Pneumococcal conjugate, 13 valent, for intramuscular use
  *Replaces 90669 7/1/2010
• Children, ages 2+
  90656 - Influenza virus vaccine, split virus, preservative free, when administered to individuals 3 years and older, for intramuscular use
  90658 - Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use
  90732 - Pneumococcal polysaccharide vaccine, 23-valent, adult or immunosuppressed patient dosage, when administered to individuals 2 years or older, for subcutaneous or intramuscular use
• Children, under age 9
  Reimbursement for administration of both doses of seasonal influenza are eligible in the following situations as indicated by HEALTH:
  
  
  
  
  If they did not receive H1N1 flu vaccine last year*
  First time ever receiving flu vaccine*
  Received seasonal flu last year, but only one dose was administered
• Adults 19-65*
  90656 - Influenza virus vaccine, split virus, preservative free, when administered to individuals 3 years and older, for intramuscular use
  90658 - Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use
  90660 – Influenza virus vaccine, live, for intranasal use (members aged 19-49 only)
  90732 - Pneumococcal polysaccharide vaccine, 23-valent, adult or immunosuppressed patient dosage, when administered to individuals 2 years or older, for subcutaneous or intramuscular use
  *Members who are enrolled on Extended Family Planning (EFP) benefits are not eligible.
• Vaccine Administration Coding (under 8 years) 90465 – Initial IM
  90466 - Subsequent IM (add-on code)
  90467 – Initial oral/nasal
  90468 – Subsequent oral/nasal (add-on code)
  90465 & 90467 will bundle when billed together on the same day and deny.
• Vaccine Administration Coding (all ages)
  90471 - Initial IM
  90472 – Subsequent IM (add-on code)
  90473 – Initial oral/nasal
  90474 – Subsequent oral nasal (add-on code)
  90471 & 90473 will bundle and deny if billed together on the same day