Seasonal Influenza Vaccines Pricing

The Medicare Part B payment allowance limits for seasonal influenza and pneumococcal vaccines are 95% of the Average Wholesale Price (AWP) as reflected in the published compendia except where the vaccine is furnished in a hospital outpatient department.  When the vaccine is furnished in the hospital outpatient department, payment for the vaccine is based on reasonable cost.

Annual Part B deductible and coinsurance amounts do not apply for the influenza virus and the pneumococcal vaccinations.  All physicians, non-physician practitioners, and suppliers who administer these vaccinations must take assignment on the claim for the vaccine.

To better conform to the Center for Disease Control and Prevention’s (CDC) recommendations for the prevention and control of influenza, CMS is changing the payment limit effective date from September 1 to August 1. Recent CDC recommendations state that vaccination efforts should begin as soon as the seasonal influenza vaccine is available and continue through the influenza season. Please see Transmittal 2424 in the Downloads section for more information.

The payment allowances below reflect the annually updated payment allowance for the listed CPT codes and Q-codes when the vaccines are furnished outside the hospital outpatient department.

Payment Allowances Effective for Dates of Service between August 1, 2012 and July 31, 2013 as specified below

CPT 90654: $18.981
CPT 90655: $16.456
CPT 90656: $12.398
CPT 90657: $6.023
CPT 90660: $23.456
CPT 90662: $30.923

Q2035 (Afluria): $11.543
Q2036 (Flulaval): $9.833
Q2037 (Fluvirin): $14.051
Q2038 (Fluzone): $12.046
Q2034 (Agriflu): locally priced
Q2039 (N.O.S.): locally priced

Additional information on 2012-2013 Influenza Vaccines pricing is available in MM8047 which is available in the 'Downloads' section below.

Payment Allowances Effective for Dates of Service between September 1, 2011 and July 31, 2012 as specified below

CPT 90654: $18.383
CPT 90655: $15.705
CPT 90656: $12.375
CPT 90657: $6.653
CPT 90660: $22.316
CPT 90662: $30.923

Q2035 (Afluria): $11.543
Q2036 (Flulaval): $8.784
Q2037 (Fluvirin): $13.652
Q2038 (Fluzone): $13.306
Q2039 (N.O.S.): locally priced

Additional information on 2011-2012 Influenza Vaccines pricing is available in MM7575 which is available in the 'Downloads' section below.

Payment Allowances Effective for Dates of Service between September 1, 2010 and August 31, 2011 as specified below

Dates of Service between September 1, 2010 and August 31, 2011

CPT 90655: $14.858
CPT 90656: $12.375
CPT 90657: $6.297
CPT 90660: $22.316
CPT 90662: $29.213

Dates of Service between September 1, 2010 and December 31, 2010

CPT 90658: $11.368

Dates of Service between October 1, 2010 and August 31, 2011

Q2035 (Afluria): locally priced
Q2036 (Flulaval): $8.784
Q2037 (Fluvirin): $13.253
Q2038 (Fluzone): $12.593
Q2039 (N.O.S.): locally priced

Additional information on 2010 Influenza Vaccines pricing is available in MM7120 and MM7234 which are available in the 'Downloads' section below.

Payment Allowances Effective for Dates of Service between September 1, 2009 and August 31, 2010

CPT 90655: $15.447
CPT 90656: $12.541
CPT 90657: $5.684
CPT 90658: $11.368
CPT 90660: $22.316

Additional information on 2009 Influenza Vaccines pricing is available in MM6608 which is available in the 'Downloads' section below.

Payment Allowances Effective for Dates of Service between September 1, 2008 and August 31, 2009

CPT 90655: $16.879
CPT 90656: $18.198
CPT 90657: $6.609
CPT 90658: $13.218
CPT 90660: $22.316

Additional information on 2008 Influenza and Pneumococcal Vaccines pricing is available in MM6153, which is available in the 'Downloads' section below.

Payment Allowances Effective for Dates of Service between September 1, 2007 and August 31, 2008

CPT 90655: $16.109
CPT 90656: $17.366
CPT 90657: $6.609
CPT 90658: $13.218
CPT 90660: $21.176

Additional information on 2007 Influenza and Pneumococcal Vaccines pricing is available in MM5744 and MM5910, which are available in the 'Downloads' section below.