Medicare CPT 90662 - Fluzone High-Dose BILLING requirements

CPT 90662 - Fluzone High-Dose (Influenza Virus Vaccine) is Covered Under Medicare Part B

Fluzone High-Dose is an inactivated influenza virus vaccine indicated for active immunization of persons 65 years of age and older against those virus subtypes A and type B contained within the vaccine. There have been no controlled clinical studies demonstrating a decrease in influenza incidence after vaccination with Fluzone High-Dose, when compared to standard dose flu vaccines.

There are two flu vaccines called Fluzone: Fluzone and Fluzone High-Dose. Fluzone is billed using CPT 90658, whereas Fluzone High-Dose is billed using CPT 90662.

Per the Food and Drug Administration’s approved labeling, Fluzone High-Dose is only covered by Medicare for beneficiaries age 65 or older.

Medicare’s reimbursement is $11.37 for Fluzone, CPT 90658. Recently, CMS published that $29.21 as the current fee schedule for Fluzone High-Dose, CPT 90662. Please remember that reimbursement for both vaccines may change when CMS issues the average sales price (ASP) drug pricing updates on October 1, 2010.

CMS is also reminding physicians that except for the H1N1 flu vaccine, Medicare normally covers only one administration of any influenza vaccine per flu season (July 1, 2010–March 31, 2011).