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Reader Question: Factor Patient's Age in This Flu Shot Scenario

- Published on Wed, Feb 21, 2018

Question: A 57-year-old patient came in for a flu shot, but when we billed 90662 we got denied. What vaccine code should we have billed?

Oregon Subscriber

Answer: The descriptor for 90662 (Influenza virus vaccine (IIV), split virus, preservative free, enhanced immunogenicity via increased antigen content, for intramuscular use) does not specify an age range. However, this service is usually only covered by payers when the patient is age 65 or older.

This is because 90662 describes a high-dose variant of the vaccine (as the words "enhanced" and "increased antigen content" in the descriptor indicate), which the Food and Drug Administration (FDA) regard as being more appropriate for a patient older than the one seen by your provider. Because of that, Medicare and payers that follow its guidelines will not cover 90662 for beneficiaries under the age of 65.

As a reminder, CPT® guidelines recommend you "refer to the product's prescribing information for the licensed age indication before administering a vaccine to a patient." You can also consult the Immunization Action Coalition's chart, which correlates vaccines with their appropriate age group and CPT®/HCPCS code, at http://www.immunize.org/catg.d/p4072.pdf. 

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