2025 Influenza and Pneumococcal Vaccines and Administration Reimbursement

The following services are paid at 100 percent of the established fee schedule amount. Coinsurance and the annual deductible do not apply. 

• Payment allowances for influenza vaccines are effective August 1, 2024, unless stated otherwise
• Influenza and pneumococcal vaccine payment allowances are subject to change on a quarterly basis*
• Administration payment allowances are updated annually on January 1

* Quarterly changes to influenza and pneumococcal vaccine payment allowances can be located on the CMS website.

Influenza, and Pneumococcal Administration Codes and Fees

Following are the 2024 influenza and pneumococcal administration fees for dates of service January 1 – December 31, 2024.

Table 1. Influenza, and Pneumococcal Administration Codes and Fees.

Influenza Virus Vaccine National Fees Effective August 1, 2024 – July 31, 2025. 
The 2024/2025 flu season fees are listed below. Contractors are required to implement these fees no later than September 27, 2024. Palmetto GBA implemented the following fees on August 28, 2024, for dates of service August 1, 2024, and after. All claims processed and paid prior to August 28, 2024, will be automatically adjusted. No further action is required.

**90660 Effective Aug. 6, 2024.

Table 2. Influenza Virus Vaccine National Fees Effective August 1, 2024 – July 31, 2025.

COVID-19 Administration Code and Fees
Following are the 2024/2025 COVID-19 administration fees effective January 1, 2024.

Table 3. COVID-19 Administration Code and Fees.

*Important: Please verify coding where there is no fee. This is usually an indication that there are no sources available to establish a fee. If billing a code with fee pending, you will need to provide a valid NDC for the current 2024/2025 flu season. Your claim will be rejected if incorrectly coded. The following HCPCS code to NDC crosswalk is made available for your reference. Note that some sources listed in this cross-walk represent 2019/2020. 2021/2022, 2022/2023 and 2023/2024 flu season vaccines. These resources could be rejected if provided during the current 2024/2025 flu season. This information is also located on the CMS website.

Excerpt from CMS file: October 2024 AWP NDC-HCPCS Crosswalk_00000.xlsx

Table 4. Excerpt from October 2024 CMS File.

Disclaimer: The above list may not be all-inclusive. Please be sure you are providing vaccines appropriate for the current 2024/2025 flu season.

Pneumococcal Vaccine National Fees 
The fees provided below are subject to change with each quarterly drug update. For current fees, please check the CMS website.

Table 5. Pneumococcal Vaccine National Fees.

Reference documents:

• CR 13802 (PDF) January 2025 Quarterly Average Sales Price [ASP] Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files 
   
• CR 13718 (PDF) Influenza Vaccine Payment Allowances – Annual Update for 2024-2025 Season
   
• CR 12439 (PDF) Claims Processing Instructions for the New Pneumococcal 15-valent Conjugate Vaccine Code 90671 and Pneumococcal 20- valent Conjugate Vaccine Code 90677
   
• Seasonal Influenza Vaccines Pricing