2022 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, 2021, 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 2022 influenza and pneumococcal administration fees for dates of service January 1, 2022 through December 31, 2022.
|
HCPCS Codes |
Description |
Ala. FSY 2022 Amount |
Tenn. FSY 2022 |
Ga.-01 FSY 2022 |
Ga.-99 FSY 2022 |
|---|---|---|---|---|---|
|
G0008 |
Admin influenza virus vac. |
$27.92 |
$27.70 |
$30.00 |
$27.72 |
|
G0009 |
Admin pneumococcal vaccine |
$27.92 |
$27.70 |
$30.00 |
$27.72 |
Influenza Virus Vaccine National Fees — Effective August 1, 2022 – July 31, 2023
The 2021/2022 flu season fees are listed below. Contractors are required to implement these fees no later than October 1, 2021. Palmetto GBA implemented the following fees on September 12, 2022, for dates of service August 1, 2022 and after. All claims processed and paid prior to September 12, 2022 will be automatically adjusted. No further action is required.
| CPT® Codes |
Description |
08/01/22 – 7/31/23 Amount |
|---|---|---|
|
90630* |
Flu vacc iiv4 no preserv id |
Pending |
|
90653 |
Iiv adjuvant vaccine im |
Pending |
|
90654* |
Flu vacc iiv3 no preserv id |
Pending |
|
90655* |
Iiv3 vacc no prsv 0.25 ml im |
Pending |
|
90656* |
Iiv3 vacc no prsv 0.5 ml im |
Pending |
|
90657* |
Iiv3 vaccine splt 0.25 ml im |
Pending |
|
90661* |
Cciiv3 vac no prsv 0.5 ml im |
Pending |
|
90662 |
Iiv no prsv increased ag im |
$69.94 |
|
90672 |
Laiv4 vaccine intranasal |
$26.88 |
|
90673* |
Riv3 vaccine no preserv im |
Pending |
|
90674 |
Cciiv4 vac no prsv 0.5 ml im |
$32.28 |
|
90682 |
Riv4 vacc recombinant dna im |
$69.94 |
|
90685* |
Iiv4 vacc no prsv 0.25 ml im |
Pending |
|
90686 |
Iiv4 vacc no prsv 0.5 ml im |
$21.52 |
|
90687 |
Iiv4 vaccine splt 0.25 ml im |
$10.24 |
|
90688 |
Iiv4 vaccine splt 0.5 ml im |
$20.48 |
|
90689* |
Vacc iiv4 no prsrv 0.25 ml im |
Pending |
|
90694 |
Quadrivalent(aIIV4) inactivated, adjuvanted, pres free,0.5ml |
$71.68 |
|
90756 |
Cciiv4 vacc abx free im |
$30.58 |
|
Q2035* |
Afluria vacc, 3 yrs & >, im |
Pending |
|
Q2036* |
Flulaval vacc, 3 yrs & >, im |
Pending Please see IMPORTANT footnote below |
|
Q2037* |
Fluvirin vacc, 3 yrs & >, im |
Pending Please see IMPORTANT footnote below |
|
Q2038* |
Fluzone vacc, 3 yrs & >, im |
Pending Please see IMPORTANT footnote below |
|
Q2039 |
Influenza virus vaccine, nos |
Specify Drug Name; May Require Invoice |
* Important: Please verify coding where a fee is pending. 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 2022/2023 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 crosswalk represent 2017/2018, 2018/2019, 2019/2020. 2021/2022 and 2022/2023 flu season vaccines. These resources could be rejected if provided during the current 2022/2023 flu season. This information is also located on the CMS website.
Excerpt from CMS file: Oct 2022 AWP NDC-HCPCS Crosswalk_08292022.xlsx
| CPT® Codes |
Short Descriptor |
Labeler Name |
NDC |
Drug Name |
|---|---|---|---|---|
|
90630 |
Flu vacc iiv4 no preserv id |
Sanofi Pasteur |
49281-0712-40 |
Fluzone Intradermal Quadrivalent (Preservative Free) (2017/2018) |
|
90653 |
Iiv adjuvant vaccine im |
Seqirus Inc. |
70461-0018-03 |
Fluad (Preservative Free) (2018/2019) |
|
90653 |
Liv adjuvant vaccine im |
Seqirus Inc. |
70461-0019-03 |
Fluad (2019/2020) |
|
90653 |
Liv adjuvant vaccine im |
Seqirus Inc. |
70461-0020-03 |
Fluad (2020/2021) |
|
90656 |
IIV3 VACC NO PRSV 0.5 ML IM |
Seqirus Inc. |
33332-0018-01 |
Afluria (Preservative Free) (2018/2019) |
|
90662 |
Iiv no prsv increased ag im |
Sanofi Pasteur |
49281-0403-65 |
Fluzone High-Dose (Preservative Free) (2018/2019) |
|
90662 |
Liv no prsv increased |
Sanofi Pasteur |
49281-0405-65 |
Fluzone High-Dose (2019/2020) |
|
90662 |
Liv no prsv increased ag im |
Sanofi Pasteur |
49281-0122-65 |
Fluzone High-Dose (Preservative Free) (2022/2023) |
|
90662 |
Iiv no prsv increased ag im |
Sanofi Pasteur |
49281-0403-65 |
Fluzone High-Dose (2019/2020) |
|
90662 |
Iiv no prsv increased ag im |
Sanofi Pasteur |
49281-0120-65 |
Fluzone High-Dose Quadrivalent (2020/2021) |
|
90662 |
Iiv no prsv increased ag im |
Sanofi Pasteur |
49281-0121-65 |
Fluzone High-Dose Quadrivalent (2021/2022) |
|
90672 |
Laiv4 vaccine intranasal |
MedImmune, LLC |
66019-0305-10 |
FluMist Quadrivalent (2018/2019) |
|
90672 |
Laiv4 vaccine intranasal |
MedImmune, LLC |
66019-0306-10 |
FluMist Quadrivalent (2019/2020) |
|
90672 |
Laiv4 vaccine intranasal |
MedImmune, LLC |
66019-0307-10 |
FluMist Quadrivalent (2020/2021) |
|
90672 |
Laiv4 vaccine intranasal |
MedImmune, LLC |
66019-0308-10 |
FluMist Quadrivalent (2021/2022) |
|
90674 |
CCIIV4 VAC NO PRSV 0.5 ML IM |
Seqirus Inc. |
70461-0318-03 |
Flucelvax Quadrivalent (Preservative Free) (2018/2019) |
|
90674 |
CCIIV4 VAC NO PRSV 0.5 ML IM |
Seqirus Inc. |
70461-0319-03 |
Flucelvax Quadrivalent (Preservative Free) (2019/2020) |
|
90674 |
CCIIV4 VAC NO PRSV 0.5 ML IM |
Seqirus Inc. |
70461-0320-03 |
Flucelvax Quadrivalent (Preservative Free) (2020/2021) |
|
90674 |
CCIIV4 VAC NO PRSV 0.5 ML IM |
Seqirus Inc. |
70461-0321-03 |
Flucelvax Quadrivalent (Preservative Free) (2021/2022) |
|
90674 |
CCIIV4 VAC NO PRSV 0.5 ML IM |
Seqirus Inc. |
70461-0322-03 |
Flucelvax Quadrivalent (Preservative Free) (2022/2023) |
|
90682 |
RIV4 VACC RECOMBINANT DNA IM |
Sanofi Pasteur |
49281-0718-10 |
Flublok Quadrivalent (Preservative Free) (2018/2019) |
|
90682 |
RIV4 VACC RECOMBINANT DNA IM |
Sanofi Pasteur |
49281-0719-10 |
Flublok Quadrivalent (2019/2020) |
|
90682 |
RIV4 VACC RECOMBINANT DNA IM |
Sanofi Pasteur |
49281-0720-10 |
Flublok Quadrivalent (2020/2021) |
|
90682 |
RIV4 VACC RECOMBINANT DNA IM |
Sanofi Pasteur |
49281-0721-10 |
Flublok Quadrivalent (2021/2022) |
|
90682 |
RIV4 VACC RECOMBINANT DNA IM |
Sanofi Pasteur |
49281-0722-10 |
Flublok Quadrivalent (Preservative Free) (2022/2023) |
|
90685 |
IIV4 VACC NO PRSV 0.25 ML IM |
Sanofi Pasteur |
49281-0518-25 |
Fluzone Quadrivalent Pediatric (Preservative Free) (2018/2019) |
|
90685 |
IIV4 VACC NO PRSV 0.25 ML IM |
Sanofi Pasteur |
49281-0519-25 |
Fluzone Quadrivalent 0,25ml (2019/2020) |
|
90685 |
IIV4 VACC NO PRSV 0.25 ML IM |
Seqirus Inc. |
33332-0219-20 |
Afluria Quadrivalent 0.25ml (Preservative Free) (2019/2020) |
|
90685 |
IIV4 VACC NO PRSV 0.25 ML IM |
Sanofi Pasteur |
49281-0520-25 |
Fluzone Quadrivalent 0,25ml (Preservative Free) (2020/2021) |
|
90685 |
IIV4 VACC NO PRSV 0.25 ML IM |
Seqirus Inc. |
33332-0220-20 |
Afluria Quadrivalent 0.25ml (Preservative Free) (2020/2021) |
|
90685 |
IIV4 VACC NO PRSV 0.25 ML IM |
Sanofi Pasteur |
49281-0521-25 |
Fluzone Quadrivalent 0,25ml (Preservative Free) (2021/2022) |
|
90685 |
IIV4 VACC NO PRSV 0.25 ML IM |
Seqirus Inc. |
33332-0221-20 |
Afluria Quadrivalent 0.25ml (Preservative Free) (2021/2022) |
|
90686 |
IIV4 VACC NO PRSV 0.5 ML IM |
Seqirus Inc. |
33332-0318-01 |
Afluria Quadrivalent (Preservative Free) (2018/2019) |
|
90686 |
IIV4 VACC NO PRSV 0.5 ML IM |
GlaxoSmithKline |
58160-0898-52 |
Fluarix Quadrivalent (Preservative Free) (2018/2019) |
|
90686 |
IIV4 VACC NO PRSV 0.5 ML IM |
GlaxoSmithKline |
19515-0909-52 |
Flulaval Quadrivalent (Preservative Free) (2018/2019) |
|
90686 |
IIV4 VACC NO PRSV 0.5 ML IM |
Sanofi Pasteur |
49281-0418-50 |
Fluzone Quadrivalent (Preservative Free) (2018/2019) |
|
90686 |
IIV4 VACC NO PRSV 0.5 ML IM |
Sanofi Pasteur |
49281-0418-10 |
Fluzone Quadrivalent (Preservative Free) (2018/2019) |
|
90686 |
IIV4 VACC NO PRSV 0.5 ML IM |
GlaxoSmithKline |
58160-0896-52 |
Fluarix Quadrivalent (Preservative Free) (2019/2020) |
|
90686 |
IIV4 VACC NO PRSV 0.5 ML IM |
GlaxoSmithKline |
19515-0906-52 |
Flulaval Quadrivalent (Preservative Free) (2019/2020) |
|
90686 |
IIV4 VACC NO PRSV 0.5 ML IM |
Sanofi Pasteur |
49281-0419-50 |
Fluzone Quadrivalent (Preservative Free) (2019/2020) |
|
90686 |
IIV4 VACC NO PRSV 0.5 ML IM |
Sanofi Pasteur |
49281-0419-10 |
Fluzone Quadrivalent (Preservative Free) (2019/2020) |
|
90686 |
IIV4 VACC NO PRSV 0.5 ML IM |
Seqirus Inc. |
33332-0319-01 |
Afluria Quadrivalent (Preservative Free) (2019/2020) |
|
90686 |
IIV4 VACC NO PRSV 0.5 ML IM |
GlaxoSmithKline |
58160-0885-52 |
Fluarix Quadrivalent (Preservative Free) (2020/2021) |
|
90686 |
IIV4 VACC NO PRSV 0.5 ML IM |
GlaxoSmithKline |
19515-0816-52 |
Flulaval Quadrivalent (Preservative Free) (20202021) |
|
90686 |
IIV4 VACC NO PRSV 0.5 ML IM |
Sanofi Pasteur |
49281-0420-50 |
Fluzone Quadrivalent (Preservative Free) (2020/2021) |
|
90686 |
IIV4 VACC NO PRSV 0.5 ML IM |
Sanofi Pasteur |
49281-0420-10 |
Fluzone Quadrivalent (Preservative Free) (2020/2021) |
|
90686 |
IIV4 VACC NO PRSV 0.5 ML IM |
Seqirus Inc. |
33332-0320-01 |
Afluria Quadrivalent (Preservative Free) (2020/2021) |
|
90686 |
IIV4 VACC NO PRSV 0.5 ML IM |
GlaxoSmithKline |
58160-0887-52 |
Fluarix Quadrivalent (Preservative Free) (2021/2022) |
|
90686 |
IIV4 VACC NO PRSV 0.5 ML IM |
ID Biomedical Corp |
19515-0818-52 |
Flulaval Quadrivalent (Preservative Free) (20212022) |
|
90686 |
IIV4 VACC NO PRSV 0.5 ML IM |
Sanofi Pasteur |
49281-0421-50 |
Fluzone Quadrivalent (Preservative Free) (2021/2022) |
|
90686 |
IIV4 VACC NO PRSV 0.5 ML IM |
Sanofi Pasteur |
49281-0421-10 |
Fluzone Quadrivalent (Preservative Free) (2021/2022) |
|
90686 |
IIV4 VACC NO PRSV 0.5 ML IM |
Seqirus Inc. |
33332-0321-01 |
Afluria Quadrivalent (Preservative Free) (2021/2022) |
|
90686 |
IIV4 VACC NO PRSV 0.5 ML IM |
GlaxoSmithKline |
58160-0890-52 |
Fluarix Quadrivalent (2022/2023) (Preservative free) |
|
90686 |
IIV4 VACC NO PRSV 0.5 ML IM |
GlaxoSmithKline |
19515-0808-52 |
Fluarix Quadrivalent (2022/2023) (Preservative free) |
|
90686 |
IIV4 VACC NO PRSV 0.5 ML IM |
Sanofi Pasteur |
49281-0422-50 |
Fluzone Quadrivalent (2022/2023) (Preservative Free) |
|
90686 |
IIV4 VACC NO PRSV 0.5 ML IM |
Sanofi Pasteur |
49281-0422-10 |
Fluzone Quadrivalent (2022/2023) (Preservative Free) |
|
90686 |
IIV4 VACC NO PRSV 0.5 ML IM |
Seqirus |
33332-0322-03 |
Afluria Quadrivalent (2022/2023) (Preservative Free) |
|
90687 |
IIV4 VACCINE SPLT 0.25 ML IM |
Sanofi Pasteur |
49281-0629-15 |
Fluzone Quadrivalent (2018/2019) |
|
90687 |
IIV4 VACCINE SPLT 0.25 ML IM |
Sanofi Pasteur |
49281-0631-15 |
Fluzone Quadrivalent 0.25ml (2019/2020) |
|
90687 |
IIV4 VACCINE SPLT 0.25 ML IM |
Seqirus Inc. |
3332-0419-10 |
Afluria Quadrivalent 0.25ml (2019/2020) |
|
90687 |
IIV4 VACCINE SPLT 0.25 ML IM |
Sanofi Pasteur |
49281-0633-15 |
Fluzone Quadrivalent 0.25ml (2020/2021) |
|
90687 |
IIV4 VACCINE SPLT 0.25 ML IM |
Seqirus Inc. |
33332-0420-10 |
Afluria Quadrivalent 0.25ml (2020/2021) |
|
90687 |
IIV4 VACCINE SPLT 0.25 ML IM |
Sanofi Pasteur |
49281-0635-15 |
Fluzone Quadrivalent 0.25ml (2021/2022) |
|
90687 |
IIV4 VACCINE SPLT 0.25 ML IM |
Seqirus Inc. |
33332-0421-10 |
Afluria Quadrivalent 0.25ml (2021/2022) |
|
90687 |
IIV4 VACCINE SPLT 0.25 ML IM |
Sanofi Pasteur |
49281-0637-15 |
Fluzone Quadrivalent 0.25ml (2022/2023) |
|
90687 |
IIV4 VACCINE SPLT 0.25 ML IM |
Seqirus |
33332-0422-10 |
Afluria Quadrivalent 0.25ml (2022/2023) |
|
90688 |
IIV4 VACCINE SPLT 0.5 ML IM |
Seqirus Inc. |
33332-0418-10 |
Afluria Quadrivalent (2018/2019) |
|
90688 |
IIV4 VACCINE SPLT 0.5 ML IM |
GlaxoSmithKline |
19515-0900-11 |
Flulaval Quadrivalent (2018/2019) |
|
90688 |
IIV4 VACCINE SPLT 0.5 ML IM |
Sanofi Pasteur |
49281-0629-15 |
Fluzone Quadrivalent (2018/2019) |
|
90688 |
IIV4 VACCINE SPLT 0.5 ML IM |
GlaxoSmithKline |
19515-0897-11 |
Flulaval Quadrivalent (2019/2020) |
|
90688 |
IIV4 VACCINE SPLT 0.5 ML IM |
Sanofi Pasteur |
49281-0631-15 |
Fluzone Quadrivalent (2019/2020) |
|
90688 |
IIV4 VACCINE SPLT 0.5 ML IM |
Seqirus Inc. |
33332-0419-10 |
Afluria Quadrivalent (2019/2020) |
|
90688 |
IIV4 VACCINE SPLT 0.5 ML IM |
Sanofi Pasteur |
49281-0633-15 |
Fluzone Quadrivalent (2020/2021) |
|
90688 |
IIV4 VACCINE SPLT 0.5 ML IM |
Seqirus Inc. |
33332-0420-10 |
Afluria Quadrivalent (2020/2021) |
|
90688 |
IIV4 VACCINE SPLT 0.5 ML IM |
Sanofi Pasteur |
49281-0635-15 |
Fluzone Quadrivalent (2021/2022) |
|
90688 |
IIV4 VACCINE SPLT 0.5 ML IM |
Seqirus Inc. |
33332-0421-10 |
Afluria Quadrivalent (2021/2022) |
|
90688 |
VACC AIIV4 NO PRSRV 0.5ML IM |
Seqirus Inc. |
70461-0121-03 |
Fluad Quadrivalent (2021/2022) |
|
90688 |
IIV4 VACCINE SPLT 0.5 ML IM |
Sanofi Pasteur |
49281-0637-15 |
Fluzone Quadrivalent (2022/2023) |
|
90688 |
IIV4 VACCINE SPLT 0.5 ML IM |
Seqirus Inc. |
33332-0422-10 |
Afluria Quadrivalent (2022/2023) |
|
90694 |
VACC AIIV4 NO PRSRV 0.5ML IM |
Seqirus Inc. |
70461-0120-03 |
Fluad Quadrivalent (2020/2021) |
|
90694 |
VACC AIIV4 NO PRSRV 0.5ML IM |
Seqirus Inc. |
70461-0120-03 |
Fluad Quadrivalent (2020/2021) |
|
90694 |
VACC AIIV4 NO PRSRV 0.5ML IM |
Seqirus Inc. |
70461-0122-03 |
Fluad Quadrivalent (2022/2023) (Preservative Free) |
|
90756 |
CCIIV4 VACC ABX FREE IM |
Seqirus Inc. |
70461-0418-10 |
Flucelvax Quadrivalent (2018/2019) |
|
90756 |
CCIIV4 VACC ABX FREE IM |
Seqirus Inc. |
70461-0419-10 |
Flucelvax Quadrivalent (2019/2020) |
|
90756 |
CCIIV4 VACC ABX FREE IM |
Seqirus Inc. |
70461-0420-10 |
Flucelvax Quadrivalent (2020/2021) |
|
90756 |
CCIIV4 VACC ABX FREE IM |
Seqirus Inc. |
70461-0421-10 |
Flucelvax Quadrivalent (2021/2022) |
|
90756 |
CCIIV4 VACC ABX FREE IM |
Seqirus Inc. |
70461-0422-10 |
Flucelvax Quadrivalent (2022/2023) |
|
Q2035 |
Afluria vacc, 3 yrs & >, im |
Seqirus Inc. |
33332-0118-10 |
Afluria (2018/2019) |
Disclaimer: The above list may not be all-inclusive. Please be sure you are providing vaccines appropriate for the current 2022/2023 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.
|
CPT® |
Description |
1/01/22 |
04/01/22 |
07/01/22 |
10/01/22 |
|---|---|---|---|---|---|
|
90670 |
Pneumococcal vacc, 13 val im |
$241.38 |
$257.99 |
$257.99 |
$257.99 |
|
90671 |
Pneumococcal Conj vacc, 15 val |
$246.20 |
$246.20 |
$246.20 |
$246.20 |
|
90677 |
Pneumococcal Conj vacc, 20 val |
$264.74 |
$283.72 |
$283.72 |
$283.72 |
|
90732 |
Pneumococcal vaccine |
$133.47 |
$133.47 |
$133.47 |
$133.47 |
Reference Documents
- CR 12788 October 2022 Quarterly Average Sales Price [ASP] Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files
- CR 12685 July 2022 Quarterly Average Sales Price [ASP] Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files
- CR 12559 April 2022 Quarterly Average Sales Price [ASP] Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files
- CR 12469 January 2022 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files
- CR 12421 Influenza Vaccine Payment Allowances — Annual Update for 2021/2022 Season
- CR 12439 Claims Processing Instructions for the New Pneumococcal 15-valent Conjugate Vaccine Code 90671 and Pneumococcal 20- valent Conjugate Vaccine Code 90677