From January 1, 2019 we will be using a new influenza virus vaccine CPT code 90689 (Influenza virus vaccine quadrivalent (IIV4). The short descriptor is VACC IIV4 NO PRSRV 0.25ML IM. This new code will be included on the 2019 Medicare Physician Fee Schedule Database file update and the annual Healthcare Common Procedure Coding System (HCPCS) update.
The new influenza virus vaccine code 90689 is not retroactive to August 1, 2018. No claims should be accepted for influenza virus vaccine code 90689 between the DOS August 1, 2018, and December 31, 2018.
Read also: New added ICD 10 codes for 2019
Full description of CPT code 90689
90689 – Influenza virus vaccine quadrivalent (IIV4), inactivated, adjuvanted, preservative free, 0.25 mL dosage, for intramuscular use
Payment Basis for Institutional Claims
MACs will pay for influenza virus vaccine code 90689 with a Type of Service (TOS) of V based on reasonable cost to
Hospitals (Type of Bill 12X and 13X)
Skilled Nursing Facilities (22X and 23X)
Home Health Agencies (34X)
Hospital-based renal dialysis facilities (72X)
Critical Access Hospitals (85X)
MACs will pay for influenza virus vaccine code 90689 with a TOS of V based on the lower of the actual charge or 95 percent of the Average Wholesale Price (AWP), to:
Indian Service Hospitals (IHS) (12X and 13X)
Hospices (81X and 82X)
IHS Critical Access Hospitals (85X)
Comprehensive Outpatient Rehabilitation Facilities (CORFs) (75X)
Independent Renal Dialysis Facilities (72X)
Read also: New revised ICD 10 codes for 2019
Related CPT codes for Influenza Virus Vaccine
Unlike immune globulins which provide short-term, passive immunity, a vaccine provides active, long-term immunity by exposing the recipient’s immune system to altered versions of specific viruses or bacteria that induce the immune system to produce its own antibodies against the invading micro-organism. The body then remembers how to make antibodies when exposed to the antigen again. This vaccine is administered by intramuscular injection, which is reported separately. Influenza vaccine is developed in embryonated chicken eggs. Fluid containing the virus is then harvested and inactivated with formaldehyde. The influenza virus is concentrated and purified, followed by chemical disruption to create a split virus and further purification. Quadrivalent influenza vaccines are formulated for protection against 4 influenza viruses, which include two different influenza type A strains and two influenza type B strains.
Refrences:
https://www.cms.gov/Outreach-and-Education/
