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Important information about H1N1: Medicare will cover immunizations for H1N1 influenza, also called the "swine flu." There will be no coinsurance or copayment applied to this benefit, and beneficiaries will not have to meet their deductible. H1N1 influenza vaccine is currently under production and will be available in the Fall of 2009. For more information on Medicare policy, see the link inside CMS titled, "Medicare and Pandemic Flu." For more general information on H1N1 virus, see the link outside CMS titled, "General Information on Pandemic Flu." The Medicare Part B payment allowance limits for seasonal influenza and pneumococcal vaccines are 95% of the Average Wholesale Price (AWP) as reflected in the published compendia except where the vaccine is furnished in a hospital outpatient department. When the vaccine is furnished in the hospital outpatient department, payment for the vaccine is based on reasonable cost. Annual Part B deductible and coinsurance amounts do not apply for the influenza virus and the pneumococcal vaccinations. All physicians, non-physician practitioners, and suppliers who administer these vaccinations must take assignment on the claim for the vaccine. The prices below reflect the annually updated payment allowance for the listed CPT codes when the vaccines are furnished outside the hospital outpatient department. Prices Effective September 1, 2009 CPT 90655: $15.447
CPT 90656: $12.541
CPT 90657: $5.684
CPT 90658: $11.368
CPT 90660: $22.316 Additional information on 2008 Influenza Vaccines pricing is available in Change Request (CR) 6608 which will be available in the 'Downloads' section below upon issuance. Prices Effective September 1, 2008 CPT 90655: $16.879
CPT 90656: $18.198
CPT 90657: $6.609
CPT 90658: $13.218
CPT 90660: $22.316 Additional information on 2008 Influenza and Pneumococcal Vaccines pricing is available in Change Request (CR) 6153, which is available in the 'Downloads' section below. Prices Effective September 1, 2007 CPT 90655: $16.109
CPT 90656: $17.366
CPT 90657: $6.609
CPT 90658: $13.218
CPT 90732: $29.730
Page Last Modified: 09/24/2009 11:27:07 AM
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