Flu Vaccine Billing Errors for 2024, 2025

Palmetto GBA has noticed a large number of flu vaccine claim billing errors for the 2024–2025 influenza season. It is important that providers confirm they are billing the correct CPT® code for this season’s version of the vaccine they are administering.

Flu Vaccine Billing Reminders

• The 2024–2025 annual influenza season is August 1, 2024, to July 31, 2025
   
• Flu vaccines are assigned new National Drug Codes (NDCs) for each season
   
• The correct CPT® code for the flu vaccine may also change season-to-season due to the composition of the vaccine
  
  Example: Quadrivalent vaccines and trivalent vaccines have different billing codes
   
• Using the incorrect CPT® code for a flu vaccine will result in a claim rejection
   
• Reporting the 2023–2024 flu vaccine NDC on a 2024–2025 flu vaccine claim will result in a claim denial
   
• CMS posts seasonal flu vaccine pricing on the Vaccine Pricing website. Codes without CMS pricing will be manually priced by Palmetto GBA.

Please verify coding where there is no fee. This is usually an indication that there are no sources available to establish a fee

Please see the 2024 Influenza and Pneumococcal Vaccines and Administration Reimbursement article for more information on vaccine administration rates and CPT® code to vaccine guidance.