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The Centers for Medicare & Medicaid Services (CMS) recently announced Medicare will pay for vaccine Current Procedural Terminology (CPT) code 90630 (Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, for intradermal use) for claims with dates of service on or after August 1, 2015, and claims processed on or after April 4, 2016.
Effective for dates of service on and after August 1, 2015, Medicare administrative contractors (MAC) will pay based on reasonable cost for vaccine code 90630 on institutional claims as follows:
• Hospitals – types of bill (TOB) 12x and 13x based on reasonable cost
• Skilled nursing facilities (SNFs) –TOB 22x and 23x based on reasonable cost
• Home health agencies (HHAs) – TOB 34x based on reasonable cost
• Hospital-based renal dialysis facilities (RDFs) – TOB 72x, based on reasonable cost
• Critical access hospitals (CAHs) – TOB 85x, based on reasonable cost
MACs will pay based on based on the lower of actual charge or 95 percent of the average wholesale price: