Oct. 11, 2024

Updated Payment and Coding Information for the 2024-2025 Flu Season

In preparation for the 2024-2025 flu season, the Centers for Medicare and Medicaid Services has increased payments to physicians for flu vaccines and updated coding guidance for physicians and practices billing for flu vaccine services.

Physicians should bill CPT codes 90653-90673 depending on which flu vaccine they use. These codes have payment allowances varying from $10.93 to $83.49, an overall increase from last year. All CPT codes became active Aug. 1 and will remain in use until July 31, 2025. CMS revises the code list annually. More information on vaccine pricing and coding available on the CMS website. Physicians and coding staff are advised to use a national drug code associated with the current period to ensure payment.

The Centers for Disease Control and Prevention recommends annual flu shots for everyone 6 months and older each flu season. Medicare Part B covers the seasonal flu shot. Medicare covers additional flu shots when medically necessary. Patients can get flu shots twice in a calendar year during two different flu seasons, and Medicare will pay for both shots. More on Medicare coverage for flu shots.