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2017-2018 Flu Season: Flucelvax Quadrivalent Billing Update

Posted October 27, 2017

The Centers for Disease Control and Prevention (CDC) recommends that everyone 6 months of age and older get a flu shot. Again for the 2017-2018 flu season, the nasal spray flu vaccine, also known as the live attenuated influenza vaccine (LAIV), should not be used, according to the CDC.

The American Medical Association (AMA) has released Current Procedural Terminology (CPT®) code 90756 effective for claims processed with dates of service on or after Jan. 1, 2018. According to the AMA, CPT code 90756 – Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, antibiotic free, 0.5 mL dosage, for intramuscular use – may be used to best describe preservative-containing Flucelvax Quadrivalent vials, which received U.S. Food and Drug Administration (FDA) approval as of July 7, 2017, for the 2017-2018 flu season. 

CPT code 90756 will not be effective until Jan. 1, 2018. For claims with dates of service prior to Jan. 1, 2018, National Drug Codes (NDCs) for doses using preservative-containing Flucelvax Quadrivalent 2017-2018 may be submitted with 90749 – Unlisted vaccine/toxoid or Q2039 – Influenza virus vaccine, not otherwise specified. 

CPT code 90674 – Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, preservative- and antibiotic-free, 0.5 mL dosage, for intramuscular use – may continue to be used to best describe preservative- and antibiotic-free Flucelvax Quadrivalent pre-filled syringes. 

When billing flu vaccines, please note that code descriptions may be specific to dosage, formulations such as trivalent vs. quadrivalent, preservative vs. preservative-free, or other distinctive features (i.e., split virus, recombinant DNA, cell cultures, intradermal, or intramuscular). 

As a reminder, while many Blue Cross and Blue Shield of Illinois (BCBSIL) members’ health benefit plans include influenza vaccination coverage with no member cost sharing when using a participating provider, there are some exceptions. It is important to check eligibility and benefits information to confirm details regarding copays, coinsurance and deductibles before administering the influenza vaccine to BCBSIL members. 

Note: This flu vaccine billing process does not apply to HMO members. Refer to the HMO Scope of Benefits guidelines.     

*https://www.cdc.gov/flu/about/season/flu-season-2017-2018.htm 

CPT copyright 2016 AMA. All rights reserved. CPT is a registered trademark of the AMA. 

This material is for informational purposes only and is not intended to be a definitive source for what codes should be used for any particular health care claim. Providers are instructed to submit claims using the most appropriate code based upon medical record documentation, coding guidelines and reference materials. 

Checking eligibility and/or benefit information is not a guarantee of payment. Benefits will be determined once a claim is received and will be based upon, among other things, the member’s eligibility and the terms of the member’s certificate of coverage applicable on the date services were rendered. If you have any questions, please call the number on the back of the member’s ID card.