Flu Awareness
Influenza (commonly known as the flu) is a contagious illness caused by the influenza virus infecting the respiratory system — nose, throat, lungs. Symptoms of the flu usually come on suddenly and may include some or all the following symptoms:
- Fever/chills
- Cough
- Sore throat
- Sinus congestion
- Body aches
- Headache
- Weakness or fatigue
- Vomiting/diarrhea (more common in children)
While anyone at any age can get the flu, it may cause severe illness resulting in increased health risks for senior citizens (those 65 and older), young children and infants (newborn to age five), those with specific chronic illnesses (such as obstructive pulmonary disease, asthma, diabetes, heart disease, a history of pneumonia/bronchitis), and those who are immunocompromised.
While flu seasons vary in severity, during most seasons, people 65 years and older bear the greatest burden of severe flu disease. In recent years, for example, it’s estimated that between 70 percent and 85 percent of seasonal flu-related deaths have occurred in people 65 years and older, and between 50 percent and 70 percent of seasonal flu-related hospitalizations have occurred among people in this age group.
It is for the reasons highlighted above, that The Centers for Medicare & Medicaid Services (CMS) and The Centers for Disease Control and Prevention (CDC) recommend an annual flu shot (Influenza Vaccine) for individuals over the age of six months during the months of September and October. Palmetto GBA would like to take this time to remind our providers to inform all patients of the benefits of the flu shot which include (CDC, 2024):
- Prevention of millions of cases of influenza
- Prevention of millions of flu-associated doctor’s visits
- Reduction in the severity of illness
- Decreased risk of flu-associated hospitalization
- Decreased risk of flu-associated ICU and Pediatric ICU admission
- Lower rates of cardiac events among those with heart disease
- Reduction in the risk of flu-related worsening of chronic lung diseases such as asthma, chronic obstructive pulmonary disease, and emphysema
- Protection of the unborn fetus and newborn during and post-pregnancy
- Protection of elderly, infant, immunocompromised, and chronically ill family members and loved ones
It is also imperative that providers remind all Medicare beneficiaries that Medicare Part B covers the cost of each annual immunization, as well as additional flu shots when medically necessary. Medicare beneficiaries may be vaccinated for the flu twice in a calendar year during two different flu seasons, and Medicare will cover any/all flu shots with no cost, copayment, coinsurance, or deductible charged to the patient.
Providers should also consider immunizing preferred patients 65 years and older with the preferred vaccine, as they are potentially more effective than the standard dose flu vaccine for patients that fall in this age group. Click Here to learn more about the Fluzone High-Dose Seasonal Influenza Vaccine.
To find out when patients are eligible for the flu shot, visit the CMS MLN Fact Sheet: Checking Medicare Eligibility (PDF). This valuable resource contains information regarding how to find claims billed over the last 18 months, CPT®/HCPCS codes utilized, dates of service, and the NPI of the provider who administered the previous influenza vaccine dose.
Find the most current flu season’s list of billing codes, payment allowances, and effective dates on the CMS Vaccine Pricing web page.
G0008 | Administration of influenza virus vaccine |
---|---|
90653 | Influenza virus vaccine (IIV), subunit, adjuvanted, for intramuscular use |
90656 | Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, 0.5ml dosage for intramuscular use |
90657 | Influenza virus vaccine, trivalent (IIV3), split virus, 0.25ml dosage, for intramuscular use |
90658 | Influenza virus vaccine, trivalent (IIV3), split virus, 0.5 ml dosage, for intramuscular use |
90660 | Influenza virus vaccine, trivalent (live (LAIV3), for intranasal use |
90661 | Influenza virus vaccine, trivalent (ccIIV3), derived from cell cultures, subunit, antibiotic free, 0.5 ml dosage, for intramuscular use |
90662 | Influenza virus vaccine (IIV) split virus, preservative free, enhanced immunogenicity via increased antigen content, for intramuscular use |
90673 | Influenza virus vaccine, trivalent (RIV3), derived from recombinant DNA, hemagglutinin (HA) protein only, preservative and antibiotic free, for intramuscular use |
Q2039 | Influenza virus vaccine, not otherwise specified |
ICD-10 Code: Z23 — Encounter for Immunization (Additional ICD-10 Codes May Apply)
Note: Medicare hospice providers may bill flu shot services on institutional claims.
References and Resources
- Key Facts About Influenza (Flu)
- Influenza (Flu)
- Respiratory Illnesses
- Weekly U.S. Influenza Surveillance Report
- Flu Shot
- Immunization and Vaccine Resources
- Vaccine Pricing
- Office of Minority Health: Immunizations & African Americans
- Seasonal Flu Vaccines
- Medicare Benefit Policy Manual, Chapter 15 Section 50.4.4.2 — Covered Medical and Other Health Services (PDF)
- Medicare Claims Processing Manual, Chapter 18 Section 10 — Preventive and Screening Services (PDF)