Department of Health &

CMS Manual System Human Services (DHHS)

Pub 100-04 Medicare Claims Processing Centers for Medicare &

Medicaid Services (CMS)
Transmittal 2824 Date: November 22, 2013
Change Request 8473

SUBJECT: New Influenza Virus Vaccine Code

I. SUMMARY OF CHANGES: This Change Request (CR) provides instructions for payment and CWF edits
to be updated to include influenza virus vaccine code 90673 for claims with of service on or after January 1,
2014, processed on or after April 7, 2014. This CR also removes vaccine code 90658, vaccine administration
codes G9141 and G9142, and temporary vaccine codes Q2034, Q2035, Q2036, Q2037, Q2038, and Q2039
from chapter 18 sections 1.2, 10.2.1, 10.4.1, 10.4.2, and 10.4.3. In addition, this CR corrects the effective date
of code Q2033 from 1/01/2013 to 7/01/2013.

EFFECTIVE DATE: July 1, 2013 - For code Q2033; January 1, 2014 - For code 90673
IMPLEMENTATION DATE: April 7, 2014

Disclaimer for manual changes only: The revision date and transmittal number apply only to red italicized
material. Any other material was previously published and remains unchanged. However, if this revision
contains a table of contents, you will receive the new/revised information only, and not the entire table of
contents.

II. CHANGES IN MANUAL INSTRUCTIONS: (N/A if manual is not updated)

R=REVISED, N=NEW, D=DELETED

R/N/D CHAPTER / SECTION / SUBSECTION / TITLE

R 18/1.2/Table of Preventive and Screening Services
R 18/10.2.1/Healthcare Common Procedure Coding System (HCPCS) and Diagnosis Codes
R 18/10.4.1/CWF Edits on FI/AB MAC Claims
R 18/10.4.2/CWF Edits on Carrier/AB MAC Claims
R 18/10.4.3/CWF A/B Crossover Edits for FI/AB MAC and Carrier/AB MAC Claims

III. FUNDING:
For Fiscal Intermediaries (FIs), Regional Home Health Intermediaries (RHHIs) and/or Carriers:
No additional funding will be provided by CMS; Contractors activities are to be carried out with their operating
budgets
For Medicare Administrative Contractors (MACs):
The Medicare Administrative Contractor is hereby advised that this constitutes technical direction as defined in
your contract. CMS does not construe this as a change to the MAC statement of Work. The contractor is not
obliged to incur costs in excess of the amounts allotted in your contract unless and until specifically authorized
by the Contracting Officer. If the contractor considers anything provided, as described above, to be outside the
current scope of work, the contractor shall withhold performance on the part(s) in question and immediately
notify the Contracting Officer, in writing or by e-mail, and request formal directions regarding continued
performance requirements.

IV. ATTACHMENTS:

Business Requirements
Manual Instruction

*Unless otherwise specified, the effective date is the date of service.

 Attachment - Business Requirements
Pub. 100-04 Transmittal: 2824 Date: November 22, 2013 Change Request: 8473

SUBJECT: New Influenza Virus Vaccine Code

EFFECTIVE DATE: July 1, 2013 - For code Q2033; January 1, 2014 - For code 90673
IMPLEMENTATION DATE: April 7, 2014

I. GENERAL INFORMATION

A. Background: This CR provides instruction for payment and CWF edits to be updated to include
influenza virus vaccine code 90673 for claims with dates of service on or after January 1, 2014, processed on or
after April 1, 2014. This CR also removes vaccine code 90658, vaccine administration codes G9141 and
G9142, and temporary vaccine codes Q2034, Q2035, Q2036, Q2037, Q2038, and Q2039 from chapter 18
sections 1.2, 10.2.1, 10.4.1, 10.4.2, and 10.4.3. In addition, this CR corrects the effective date of code Q2033
from 1/01/2013 to 7/01/2013.

B. Policy: Effective for claims with dates of service on or after July 1, 2013, vaccine code Q2033 will be
payable by Medicare. Effective for claims with dates of service on or after January 1, 2014, vaccine code
90673 will be payable by Medicare. Annual Part B deductible and coinsurance do not apply. All physicians,
non-physician practitioners and suppliers who administer the influenza virus vaccination must take assignment
on the claim for the vaccine.

II. BUSINESS REQUIREMENTS TABLE

"Shall" denotes a mandatory requirement, and "should" denotes an optional requirement.

Number Requirement Responsibility

A/B D F C R Shared- Other
MAC M I A H System
E R H Maintainers
A B H R I F M V C
H M I I C M W
H A E S S S F
C R S
8473.1 Contractors shall change the effective date of X X X IOCE
influenza virus vaccine code Q2033 from
1/01/2013 to 7/01/2013.

NOTE: This change is effective for claims with

dates of service on or after 7/01/2013 processed on
or after 10/07/2013. Contractors shall adjust
claims processed on or after 10/07/2013 that are
brought to their attention.

8473.2 Contractors shall update their systems to accept X X X X IOCE

influenza virus vaccine code 90673 for dates of
service on or after January 1, 2014.

8473.3 Effective for dates of service on and after January X

Number Requirement Responsibility
A/B D F C R Shared- Other
MAC M I A H System
E R H Maintainers
A B H R I F M V C
H M I I C M W
H A E S S S F
C R S
1, 2014, processed before April 7, 2014,
contractors shall use local pricing guidelines to
determine payment rates for influenza virus
vaccine code 90673. Co-insurance and deductible
do not apply.

8473.4 Effective for claims with dates of service on and X

after January 1, 2014, processed on and after April
7, 2014, contractors shall use Medicare Part B
payment limit for influenza virus vaccine code
90673 according to
HTTP://www.cms.gov/Medicare/Medicare-Fee-
for-Service-Part-B-
drugs/McrPartBDrugAvgSalesPrice/VaccinesPrici
ng.html. Co-insurance and deductible do not
apply.

8473.5 Effective for dates of service on and after January X X X

1, 2014, contractors shall pay for vaccine code
90673 as follows:

1. Hospitals (12X and 13X), SNFs (22Xand

23X), HHA (34X), hospital-based RDFs
(72X), and CAHs (85X) based on
reasonable cost.

2. IHS Hospitals (12X and 13X) and IHS

CAHs (85X) based on the lower of the
actual charge or 95% of the AWP.

3. CORFs (75X) and independent RDFs

(72X) based on the lower of actual charge
or 95% of the AWP.

Coinsurance and deductible do not apply.

8473.6 Contractors shall add influenza virus vaccine code X X

90673 to existing influenza virus vaccine edits.

8473.7 Until systems changes are implemented, X X

contractors shall hold institutional claims
containing influenza virus vaccine codes 90673
with dates of service on or after January 1, 2014,
Number Requirement Responsibility
A/B D F C R Shared- Other
MAC M I A H System
E R H Maintainers
A B H R I F M V C
H M I I C M W
H A E S S S F
C R S
received before April 1, 2014.

8473.8 Once the system changes described in this X X

instruction are implemented, contractors shall
release the held claims, appending condition code
15.

III. PROVIDER EDUCATION TABLE

Number Requirement Responsibility

A/B D F C R Other
MAC M I A H
E R H
A B H R I
H M I
H A E
C R
8473.9 MLN Article: A provider education article related to X X X X X
this instruction will be available at
http://www.cms.gov/Outreach-and-
Education/Medicare-Learning-Network-
MLN/MLNMattersArticles/ shortly after the CR is
released. You will receive notification of the article
release via the established "MLN Matters" listserv.
Contractors shall post this article, or a direct link to
this article, on their Web sites and include
information about it in a listserv message within one
week of the availability of the provider education
article. In addition, the provider education article
shall be included in the contractor’s next regularly
scheduled bulletin. Contractors are free to
supplement MLN Matters articles with localized
information that would benefit their provider
community in billing and administering the
Medicare program correctly.
IV. SUPPORTING INFORMATION

Section A: Recommendations and supporting information associated with listed requirements: N/A

"Should" denotes a recommendation.

X-Ref Recommendations or other supporting information:

Requirement
Number

Section B: All other recommendations and supporting information: N/A

V. CONTACTS

Pre-Implementation Contact(s): William Ruiz, 410-786-9283 or william.ruiz@cms.hhs.gov,

Joscelyn Lissone, 410-786-5116 or joscelyn.lissone@cms.hhs.gov

Post-Implementation Contact(s): Contact your Contracting Officer's Representative (COR) or Contractor

Manager, as applicable.

VI. FUNDING

Section A: For Fiscal Intermediaries (FIs), Regional Home Health Intermediaries (RHHIs), and/or
Carriers:
No additional funding will be provided by CMS; Contractors activities are to be carried out with their operating
budgets

Section B: For Medicare Administrative Contractors (MACs):

The Medicare Administrative Contractor is hereby advised that this constitutes technical direction as defined in
your contract. CMS do not construe this as a change to the MAC Statement of Work. The contractor is not
obligated to incur costs in excess of the amounts allotted in your contract unless and until specifically
authorized by the Contracting Officer. If the contractor considers anything provided, as described above, to be
outside the current scope of work, the contractor shall withhold performance on the part(s) in question and
immediately notify the Contracting Officer, in writing or by e-mail, and request formal directions regarding
continued performance requirements.
1.2 – Table of Preventive and Screening Services
(Rev. 2824, Issued: 11-22-13, Effective: 07-01-13, for code Q2033; January 1, 2014-for
code 90673, Implementation: 04-07-14)

CPT/
USPSTF Coins./
Service HCPCS Long Descriptor
Rating Deductible
Code
Initial preventive physical
examination; face to face
visits, services limited to
G0402 WAIVED
new beneficiary during the
first 12 months of
Medicare enrollment
Electrocardiogram, routine
ECG with 12 leads;
performed as a screening Not
G0403
for the initial preventive Waived
physical examination with
Initial interpretation and report
Preventive
Electrocardiogram, routine *Not
Physical
ECG with 12 leads; tracing Rated
Examination,
IPPE only, without interpretation
Not
G0404 and report, performed as a
Waived
screening for the initial
preventive physical
examination
Electrocardiogram, routine
ECG with 12 leads;
interpretation and report
Not
G0405 only, performed as a
Waived
screening for the initial
preventive physical
examination
Ultrasound Ultrasound, B-scan and /or
Screening for real time with image
Abdominal documentation; for
G0389 B WAIVED
Aortic abdominal aortic aneurysm
Aneurysm (AAA) ultrasound
(AAA) screening
Cardiovascular 80061 Lipid panel A WAIVED
Disease
 CPT/
USPSTF Coins./
Service HCPCS Long Descriptor
Rating Deductible
Code
Cholesterol, serum or
82465 WAIVED
whole blood, total
Lipoprotein, direct
measurement; high density
83718 WAIVED
cholesterol (hdl
cholesterol)
84478 Triglycerides WAIVED
Glucose; quantitative,
82947 WAIVED
blood (except reagent strip)
B
Glucose; post glucose dose
Diabetes 82950 WAIVED
(includes glucose)
Screening Tests
Glucose; tolerance test
*Not
82951 (gtt), three specimens WAIVED
Rated
(includes glucose)
Diabetes outpatient self-
management training Not
Diabetes Self- G0108
services, individual, per 30 Waived
Management minutes *Not
Training
Diabetes outpatient self- Rated
Services
(DSMT) management training Not
G0109
services, group session (2 Waived
or more), per 30 minutes
Medical nutrition therapy;
initial assessment and
97802 intervention, individual, WAIVED
face-to-face with the
patient, each 15 minutes
Medical
Medical nutrition therapy;
Nutrition
re-assessment and
Therapy B
97803 intervention, individual, WAIVED
(MNT)
face-to-face with the
Services
patient, each 15 minutes
Medical nutrition therapy;
group (2 or more
97804 WAIVED
individual(s)), each 30
minutes
 CPT/
USPSTF Coins./
Service HCPCS Long Descriptor
Rating Deductible
Code
Medical nutrition therapy;
reassessment and
subsequent intervention(s)
following second referral
in same year for change in
diagnosis, medical
G0270 WAIVED
condition or treatment
regimen (including
additional hours needed for
renal disease), individual,
face to face with the
patient, each 15 minutes
B
Medical nutrition therapy,
reassessment and
subsequent intervention(s)
following second referral
in same year for change in
diagnosis, medical
G0271 WAIVED
condition, or treatment
regimen (including
additional hours needed for
renal disease), group (2 or
more individuals), each 30
minutes
Screening cytopathology,
cervical or vaginal (any
reporting system),
collected in preservative
G0123 WAIVED
fluid, automated thin layer
preparation, screening by
cytotechnologist under
Screening Pap physician supervision A
Test
Screening cytopathology,
cervical or vaginal (any
reporting system),
G0124 collected in preservative WAIVED
fluid, automated thin layer
preparation, requiring
interpretation by physician
 CPT/
USPSTF Coins./
Service HCPCS Long Descriptor
Rating Deductible
Code
Screening cytopathology
smears, cervical or vaginal,
performed by automated
G0141 A WAIVED
system, with manual
rescreening, requiring
interpretation by physician
Screening cytopathology,
cervical or vaginal (any
reporting system),
collected in preservative
G0143 fluid, automated thin layer A WAIVED
preparation, with manual
screening and rescreening
by cytotechnologist under
physician supervision
Screening cytopathology,
cervical or vaginal (any
reporting system),
collected in preservative
G0144 fluid, automated thin layer A WAIVED
preparation, with screening
by automated system,
under physician
supervision
Screening cytopathology,
cervical or vaginal (any
reporting system),
collected in preservative
G0145 fluid, automated thin layer A WAIVED
preparation, with screening
by automated system and
manual rescreening under
physician supervision
Screening cytopathology
smears, cervical or vaginal,
G0147 performed by automated A WAIVED
system under physician
supervision
 CPT/
USPSTF Coins./
Service HCPCS Long Descriptor
Rating Deductible
Code
Screening cytopathology
smears, cervical or vaginal,
G0148 performed by automated WAIVED
system with manual
rescreening

Screening papanicolaou
smear, cervical or vaginal,
P3000 up to three smears, by WAIVED
technician under physician
supervision
A
Screening papanicolaou
smear, cervical or vaginal,
P3001 up to three smears, WAIVED
requiring interpretation by
physician

Screening papanicolaou
smear; obtaining, preparing
Q0091 and conveyance of cervical WAIVED
or vaginal smear to
laboratory
Cervical or vaginal cancer
Screening
G0101 screening; pelvic and A WAIVED
Pelvic Exam
clinical breast examination
Computer-aided detection
(computer algorithm
analysis of digital image
data for lesion detection)
with further physician
review for interpretation,
Screening
77052 with or without digitization B WAIVED
Mammography
of film radiographic
images; screening
mammography (list
separately in addition to
code for primary
procedure)
 CPT/
USPSTF Coins./
Service HCPCS Long Descriptor
Rating Deductible
Code
Screening mammography,
77057 bilateral (2-view film study WAIVED
of each breast)
B
Screening mammography,
G0202 producing direct digital WAIVED
image, bilateral, all views
Single energy x-ray
absorptiometry (sexa) bone
density study, one or more
G0130 WAIVED
sites; appendicular skeleton
(peripheral) (e.g., radius,
wrist, heel)
Computed tomography,
bone mineral density study,
77078 1 or more sites; axial WAIVED
skeleton (e.g., hips, pelvis,
spine)
Computed tomography,
bone mineral density study,
1 or more sites;
77079 WAIVED
appendicular skeleton
(peripheral) (e.g., radius,
Bone Mass wrist, heel)
B
Measurement
Dual-energy x-ray
absorptiometry (dxa), bone
77080 density study, 1 or more WAIVED
sites; axial skeleton (e.g.,
hips, pelvis, spine)
Dual-energy x-ray
absorptiometry (dxa), bone
density study, 1 or more
77081 WAIVED
sites; appendicular skeleton
(peripheral) (e.g., radius,
wrist, heel)
Radiographic
absorptiometry (e.g., photo
77083 densitometry, WAIVED
radiogrammetry), 1 or
more sites
 CPT/
USPSTF Coins./
Service HCPCS Long Descriptor
Rating Deductible
Code
Ultrasound bone density
measurement and
76977 WAIVED
interpretation, peripheral
site(s), any method
Colorectal cancer
G0104 screening; flexible WAIVED
sigmoidoscopy
A
Colorectal cancer
G0105 screening; colonoscopy on WAIVED
individual at high risk
Colorectal cancer
Coins.
screening; alternative to
Applies &
G0106 G0104, screening
Ded. is
sigmoidoscopy, barium
waived
enema *Not
Colorectal cancer Rated
Coins.
screening; alternative to
Colorectal Applies &
G0120 G0105, screening
Cancer Ded. is
colonoscopy, barium
Screening waived
enema.
Colorectal cancer
screening; colonoscopy on
G0121 WAIVED
individual not meeting
criteria for high risk
Blood, occult, by
peroxidase activity (e.g.,
82270 A WAIVED
guaiac), qualitative; feces,
consecutive
Colorectal cancer
screening; fecal occult
G0328 WAIVED
blood test, immunoassay,
1-3 simultaneous

Prostate cancer screening; Not

G0102
digital rectal examination Waived
Prostate Cancer
D
Screening Prostate cancer screening;
G0103 prostate specific antigen WAIVED
test (PSA)
 CPT/
USPSTF Coins./
Service HCPCS Long Descriptor
Rating Deductible
Code
Glaucoma screening for
high risk patients furnished Not
G0117
by an optometrist or Waived
ophthalmologist
Glaucoma Glaucoma screening for I
Screening high risk patient furnished
under the direct Not
G0118
supervision of an Waived
optometrist or
ophthalmologist

Influenza virus vaccine,

inactivated, subunit,
90653 WAIVED
adjuvanted, for
intramuscular use

Influenza virus vaccine,

split virus, preservative
90654 WAIVED
free, for intradermal use,
for adults ages 18-64

Influenza virus vaccine,

split virus, preservative
90655 free, when administered to WAIVED
Influenza Virus children 6-35 months of
B
Vaccine age, for intramuscular use
Influenza virus vaccine,
split virus, preservative
90656 free, when administered to WAIVED
individuals 3 years and
older, for intramuscular use
Influenza virus vaccine,
split virus, when
90657 administered to children 6- WAIVED
35 months of age, for
intramuscular use
Influenza virus vaccine,
90660 WAIVED
live, for intranasal use
 CPT/
USPSTF Coins./
Service HCPCS Long Descriptor
Rating Deductible
Code
Influenza virus vaccine,
derived from cell cultures,
90661 subunit, preservative and WAIVED
antibiotic free, for
intramuscular use
Influenza virus vaccine,
split virus, preservative
free, enhanced
90662 WAIVED
immunogenicity via
increased antigen content,
for intramuscular use
Influenza virus vaccine,
90672 live, quadrivalent, for WAIVED
intranasal use
Influenza virus vaccine,
trivalent, derived from
recombinant DNA (RIV3),
90673 hemagglutinin (HA) WAIVED
protein only, preservative
and antibiotic free, for
intramuscular use
Influenza virus vaccine,
quadrivalent, split virus,
preservative free, when
90685 WAIVED
administered to children 6-
35 months of age, for
intramuscular use
Influenza virus vaccine,
quadrivalent, split virus,
preservative free, when
90686 WAIVED
administered to individuals
3 years of age and older,
for intramuscular use
Influenza virus vaccine,
quadrivalent, split virus,
90687 when administered to WAIVED
children 6-35 months of
age, for intramuscular use
 CPT/
USPSTF Coins./
Service HCPCS Long Descriptor
Rating Deductible
Code
Influenza virus vaccine,
quadrivalent, split virus,
when administered to
90688 WAIVED
individuals 3 years of age
and older, for
intramuscular use
Administration of
G0008 WAIVED
influenza virus vaccine
Pneumococcal conjugate
vaccine, polyvalent, when
90669 administered to children WAIVED
younger than 5 years, for
intramuscular use
Pneumococcal conjugate
90670 vaccine, 13 valent, for WAIVED
intramuscular use.
Pneumococcal Pneumococcal B
Vaccine polysaccharide vaccine,
23-valent, adult or
immunosuppressed patient
90732 WAIVED
dosage, when administered
to individuals 2 years or
older, for subcutaneous or
intramuscular use
Administration of
G0009 WAIVED
pneumococcal vaccine
Hepatitis B vaccine, adult
90739 dosage (2 dose schedule), WAIVED
for intramuscular use
Hepatitis B vaccine,
dialysis or
Hepatitis B 90740 immunosuppressed patient WAIVED
A
Vaccine dosage (3 dose schedule),
for intramuscular use
Hepatitis B vaccine,
adolescent (2 dose
90743 WAIVED
schedule), for
intramuscular use
 CPT/
USPSTF Coins./
Service HCPCS Long Descriptor
Rating Deductible
Code
Hepatitis B vaccine,
pediatric/adolescent dosage
90744 WAIVED
(3 dose schedule), for
intramuscular use
Hepatitis B vaccine, adult
90746 dosage, for intramuscular WAIVED
use
Hepatitis B vaccine,
dialysis or
90747 immunosuppressed patient WAIVED
dosage (4 dose schedule),
for intramuscular use
Administration of hepatitis
G0010 A WAIVED
B vaccine
Infectious agent antigen
detection by enzyme
immunoassay (EIA)
G0432 technique, qualitative or WAIVED
semi-qualitative, multiple-
step method, HIV-1 or
HIV-2, screening
Infectious agent antigen
detection by enzyme-linked
HIV Screening A
immunosorbent assay
G0433 WAIVED
(ELISA) technique,
antibody, HIV-1 or HIV-2,
screening
Infectious agent antigen
detection by rapid antibody
G0435 test of oral mucosa WAIVED
transudate, HIV-1 or HIV-
2 , screening
Smoking and tobacco
cessation counseling visit
Smoking for the asymptomatic
G0436 A WAIVED
Cessation patient; intermediate,
greater than 3 minutes, up
to 10 minutes
 CPT/
USPSTF Coins./
Service HCPCS Long Descriptor
Rating Deductible
Code
Smoking and tobacco
cessation counseling visit
G0437 for the asymptomatic WAIVED
patient intensive, greater
than 10 minutes

Annual wellness visit,

G0438 WAIVED
including PPPS, first visit
Annual *Not
Wellness Visit Annual wellness visit, Rated
G0439 including PPPS, WAIVED
subsequent visit

10.2.1 - Healthcare Common Procedure Coding System (HCPCS) and

Diagnosis Codes
(Rev. 2824, Issued: 11-22-13, Effective: 07-01-13, for code Q2033; January 1, 2014-for
code 90673, Implementation: 04-07-14)

Vaccines and their administration are reported using separate codes. The following codes
are for reporting the vaccines only.

HCPCS Definition
90653 Influenza virus vaccine, inactivated, subunit, adjuvanted, for
intramuscular use
90654 Influenza virus vaccine, split virus, preservative-free, for intradermal
use, for adults ages 18 – 64;
90655 Influenza virus vaccine, split virus, preservative free, for children 6-
35 months of age, for intramuscular use;
90656 Influenza virus vaccine, split virus, preservative free, for use in
individuals 3 years and above, for intramuscular use;
90657 Influenza virus vaccine, split virus, for children 6-35 months of age,
for intramuscular use;
90660 Influenza virus vaccine, live, for intranasal use;
90661 Influenza virus vaccine, derived from cell cultures, subunit,
preservative and antibiotic free, for intramuscular use
90662 Influenza virus vaccine, split virus, preservative free, enhanced
immunogenicity via increased antigen content, for intramuscular use
90669 Pneumococcal conjugate vaccine, polyvalent, for children under 5
years, for intramuscular use
 HCPCS Definition

90670 Pneumococcal conjugate vaccine, 13 valent, for intramuscular use

90672 Influenza virus vaccine, live, quadrivalent, for intranasal use
90673 Influenza virus vaccine, trivalent, derived from recombinant DNA
(RIV3), hemagglutinin (HA) protein only, preservative and antibiotic
free, for intramuscular use
90685 Influenza virus vaccine, quadrivalent, split virus, preservative free,
when administered to children 6-35 months of age, for intramuscular
use
90686 Influenza virus vaccine, quadrivalent, split virus, preservative free,
when administered to individuals 3 years of age and older, for
intramuscular use
90687 Influenza virus vaccine, quadrivalent, split virus, when administered
to children 6-35 months of age, for intramuscular use
90688 Influenza virus vaccine, quadrivalent, split virus, when administered
to individuals 3 years of age and older, for intramuscular use
90732 Pneumococcal polysaccharide vaccine, 23-valent, adult or
immunosuppressed patient dosage, for use in individuals 2 years or
older, for subcutaneous or intramuscular use;
90739 Hepatitis B vaccine, adult dosage (2 dose schedule), for
intramuscular use
90740 Hepatitis B vaccine, dialysis or immunosuppressed patient dosage (3
dose schedule), for intramuscular use;
90743 Hepatitis B vaccine, adolescent (2 dose schedule), for intramuscular
use;
90744 Hepatitis B vaccine, pediatric/adolescent dosage (3 dose schedule),
for intramuscular use;
90746 Hepatitis B vaccine, adult dosage, for intramuscular use; and
90747 Hepatitis B vaccine, dialysis or immunosuppressed patient dosage (4
dose schedule), for intramuscular use.

The following codes are for reporting administration of the vaccines only. The
administration of the vaccines is billed using:

HCPCS Definition
G0008 Administration of influenza virus vaccine;
G0009 Administration of pneumococcal vaccine; and
*G0010 Administration of hepatitis B vaccine.
 *90471 Immunization administration. (For OPPS hospitals billing for the
hepatitis B vaccine administration)
*90472 Each additional vaccine. (For OPPS hospitals billing for the hepatitis
B vaccine administration)

* NOTE: For claims with dates of service prior to January 1, 2006, OPPS and non-
OPPS hospitals report G0010 for hepatitis B vaccine administration. For claims with
dates of service January 1, 2006 until December 31, 2010, OPPS hospitals report
90471 or 90472 for hepatitis B vaccine administration as appropriate in place of
G0010. Beginning January 1, 2011, providers should report G0010 for billing under
the OPPS rather than 90471 or 90472 to ensure correct waiver of coinsurance and
deductible for the administration of hepatitis B vaccine.

One of the following diagnosis codes must be reported as appropriate. If the sole
purpose for the visit is to receive a vaccine or if a vaccine is the only service billed on
a claim the applicable following diagnosis code may be used.

Diagnosis Code Description

V03.82 Pneumococcus
V04.81** Influenza
V06.6*** Pneumococcus and Influenza
V05.3 Hepatitis B

**Effective for influenza virus claims with dates of service October 1, 2003 and later.

***Effective October 1, 2006, providers may report diagnosis code V06.6 on claims for
pneumococcus and/or influenza virus vaccines when the purpose of the visit was to
receive both vaccines.

If a diagnosis code for pneumococcus, hepatitis B, or influenza virus vaccination is not

reported on a claim, contractors may not enter the diagnosis on the claim. Contractors
must follow current resolution processes for claims with missing diagnosis codes.

If the diagnosis code and the narrative description are correct, but the HCPCS code is
incorrect, the carrier or intermediary may correct the HCPCS code and pay the claim.
For example, if the reported diagnosis code is V04.81 and the narrative description (if
annotated on the claim) says "flu shot" but the HCPCS code is incorrect, contractors may
change the HCPCS code and pay for the flu vaccine. Effective October 1, 2006,
carriers/AB MACs should follow the instructions in Pub. 100-04, Chapter 1, Section
80.3.2.1.1 (Carrier Data Element Requirements) for claims submitted without a HCPCS
code.

Claims for hepatitis B vaccinations must report the I.D. Number of the referring
physician. In addition, if a doctor of medicine or osteopathy does not order the influenza
virus vaccine, the intermediary claims require:
 • UPIN code SLF000 to be reported on claims submitted prior to May 23, 2008,
when Medicare began accepting NPIs, only

• The provider’s own NPI to be reported in the NPI field for the attending physician
on claims submitted on or after May 23, 2008, when NPI requirements were
implemented.

10.4.1 - CWF Edits on FI/AB MAC Claims

(Rev. 2824, Issued: 11-22-13, Effective: 07-01-13, for code Q2033; January 1, 2014-for
code 90673, Implementation: 04-07-14)

In order to prevent duplicate payment by the same FI/AB MAC, CWF edits by line item
on the FI/AB MAC number, the beneficiary Health Insurance Claim (HIC) number, and
the date of service, the influenza virus procedure codes 90653, 90654, 90655, 90656,
90657, 90660, 90661, 90662, 90672, 90673, 90685, 90686, 90687, or 90688 and the
pneumococcal procedure codes 90669, 90670, or 90732, and the administration codes
G0008 or G0009.

If CWF receives a claim with either HCPCS codes 90653, 90654, 90655, 90656, 90657,
90660, 90661, 90662, 90672, 90673, 90685, 90686, 90687, or 90688 and it already has
on record a claim with the same HIC number, same FI/AB MAC number, same date of
service, and any one of those HCPCS codes, the second claim submitted to CWF rejects.

If CWF receives a claim with HCPCS codes 90669, 90670, or 90732 and it already has
on record a claim with the same HIC number, same FI/AB MAC number, same date of
service, and the same HCPCS code, the second claim submitted to CWF rejects when all
four items match.

If CWF receives a claim with HCPCS administration codes G0008 or G0009 and it
already has on record a claim with the same HIC number, same FI/AB MAC number,
same date of service, and same procedure code, CWF rejects the second claim submitted
when all four items match.

CWF returns to the FI/AB MAC a reject code “7262” for this edit. FIs/AB MACs must
deny the second claim and use the same messages they currently use for the denial of
duplicate claims.

10.4.2 - CWF Edits on Carrier/AB MAC Claims

(Rev. 2824, Issued: 11-22-13, Effective: 07-01-13, for code Q2033; January 1, 2014-for
code 90673, Implementation: 04-07-14)

In order to prevent duplicate payment by the same carrier/AB MAC, CWF will edit by
line item on the carrier/AB MAC number, the HIC number, the date of service, the
influenza virus procedure codes 90653, 90654, 90655, 90656, 90657, 90660, 90661,
90662, 90672, 90673, 90685, 90686, 90687, or 90688; the pneumococcal procedure
codes 90669, 90670, or 90732; and the administration code G0008 or G0009.
If CWF receives a claim with either HCPCS codes 90653, 90654, 90655, 90656, 90657,
90660, 90661, 90662, 90672, 90673, 90685, 90686, 90687, or 90688 and it already has
on record a claim with the same HIC number, same carrier/AB MAC number, same date
of service, and any one of those HCPCS codes, the second claim submitted to CWF will
reject.

If CWF receives a claim with HCPCS codes 90669, 90670, or 90732 and it already has
on record a claim with the same HIC number, same carrier/AB MAC number, same date
of service, and the same HCPCS code, the second claim submitted to CWF will reject
when all four items match.

If CWF receives a claim with HCPCS administration codes G0008 or G0009 and it
already has on record a claim with the same HIC number, same carrier/AB MAC number,
same date of service, and same procedure code, CWF will reject the second claim
submitted.

CWF will return to the carrier/AB MAC a specific reject code for this edit. Carriers/AB
MACs must deny the second claim and use the same messages they currently use for the
denial of duplicate claims.

In order to prevent duplicate payment by the centralized billing contractor and local
carrier/AB MAC, CWF will edit by line item for carrier number, same HIC number,
same date of service, the influenza virus procedure codes 90653, 90654, 90655, 90656,
90657, 90660, 90661, 90662, 90672, 90673, 90685, 90686, 90687, or 90688; the
pneumococcal procedure codes 90669, 90670, or 90732; and the administration code
G0008 or G0009.

If CWF receives a claim with either HCPCS codes 90653, 90654, 90655, 90656, 90657,
90660, 90661, 90662, 90672, 90673, 90685, 90686, 90687, or 90688 and it already has
on record a claim with a different carrier/AB MAC number, but same HIC number, same
date of service, and any one of those same HCPCS codes, the second claim submitted to
CWF will reject.

If CWF receives a claim with HCPCS codes 90669, 90670, or 90732 and it already has
on record a claim with the same HIC number, different carrier/AB MAC number, same
date of service, and the same HCPCS code, the second claim submitted to CWF will
reject.

If CWF receives a claim with HCPCS administration codes G0008 or G0009 and it
already has on record a claim with a different carrier/AB MAC number, but the same
HIC number, same date of service, and same procedure code, CWF will reject the second
claim submitted.
CWF will return a specific reject code for this edit. Carriers/AB MACs must deny the
second claim. For the second edit, the reject code should automatically trigger the
following Medicare Summary Notice (MSN) and Remittance Advice (RA) messages.

MSN: 7.2 – “This is a duplicate of a claim processed by another contractor. You should
receive a Medicare Summary Notice from them.”

Claim adjustment reason code 18 – duplicate claim or service

10.4.3 - CWF A/B Crossover Edits for FI/AB MAC and Carrier/AB
MAC Claims
(Rev. 2824, Issued: 11-22-13, Effective: 07-01-13, for code Q2033; January 1, 2014-for
code 90673, Implementation: 04-07-14)

When CWF receives a claim from the carrier/AB MAC, it will review Part B outpatient
claims history to verify that a duplicate claim has not already been posted.

CWF will edit on the beneficiary HIC number; the date of service; the influenza virus
procedure codes 90653, 90654, 90655, 90656, 90657, 90660, 90661, 90662, 90672,
90673, 90685, 90686, 90687, or 90688; the pneumococcal procedure codes 90669,
90670, or 90732; and the administration code G0008 or G0009.

CWF will return a specific reject code for this edit. Contractors must deny the second
claim and use the same messages they currently use for the denial of duplicate claims.