CODING & REIMBURSEMENT

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ACIP Recommendation for 2020/2021 Flu Season

The Centers for Disease Control and Prevention’s (CDC) Advisory Committee on Immunization Practices (ACIP) recommended that for the 2020-2021 season, immunization providers may choose to administer any licensed, age-appropriate influenza vaccine (including Live Attenuated Influenza Vaccine (LAIV), Injectable Influenza Vaccine (IIV), and recombinant Injectable Vaccine (RIV). LAIV4 is an option for influenza vaccination for persons for whom it is otherwise appropriate.1

FLUMIST® QUADRIVALENT (Influenza Vaccine Live, Intranasal) is a vaccine indicated for active immunization of persons 2-49 years of age for the prevention of influenza disease caused by influenza A subtype viruses and type B viruses contained in the vaccine. FLUMIST QUADRIVALENT is for intranasal administration only.

The American Academy of Pediatrics (AAP) recommends FLUMIST QUADRIVALENT as a vaccination option for the 2020-2021 influenza season and advises pediatricians to vaccinate their patients against influenza with either the flu shot or the nasal spray vaccine.2

It is important to note that the codes identified below are examples only. Each provider is responsible for ensuring all coding is accurate and documented in the medical record based on the condition of the patient. The use of the following codes does not guarantee reimbursement.

National Drug Code (NDC)

The National Drug Code (NDC) is a universal, unique, 3-segment number identifying drugs by manufacturer, dosage, and package size. Payers may require the submission of the 11-digit NDC on health care claim forms, and electronic claims may be denied for drugs billed without a valid 11-digit NDC. Contact your patient’s health plan to determine claim submission requirements and to determine accurate reporting of NDC codes.

10-digit NDC

Dosage
Code
10 applicators in one package
66019-307-10
0.2 mL in one applicator (applicator contained within the package of 10)
66019-307-01

11-digit NDC

Dosage
Code
10 applicators in one package
66019-0307-10
0.2 mL in one applicator (applicator contained within the package of 10)
66019-0307-01

Current Procedural Terminology (CPT®)

Submitting accurate codes and claims is important to ensure proper reimbursement of services. The chart below lists the potential Current Procedural Terminology (CPT) code for your reference when submitting claims for your FLUMIST QUADRIVALENT patients.

Code
Description

Vaccine product CPT code

90672
Influenza virus vaccine, quadrivalent, live (LAIV4), for intranasal use

Pediatric immunization administration CPT codes for patients ≤18 years of age

90460
Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; first or only component of each vaccine or toxoid administered
90461
Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; each additional vaccine or toxoid component administered (list separately in addition to code for primary procedure)

Adult immunization administration CPT codes for patients >18 years of age

90473
Immunization administration by intranasal or oral route; one vaccine (single or combination vaccine/toxoid) (Do not use 90473 in conjunction with 90471)
90474
Immunization administration by intranasal or oral route; each additional vaccine (single or combination vaccine/toxoid) (list separately in addition to code for primary procedure) (Use 90474 in conjunction with 90471 or 90473)

Diagnosis Codes

When filing claims, providers often indicate a diagnosis code reflecting the patient’s condition. Based on the Indications for FLUMIST QUADRIVALENT, examples of diagnosis codes that may be appropriate are listed below.

It is important to note that the codes identified below are examples only. Each provider is responsible for ensuring all coding is accurate and documented in the medical record based on the condition of the patient.

The use of the following code does not guarantee reimbursement.
ICD-10-CM=International Classification of Diseases, Tenth Revision, Clinical Modification.

ICD-10-CM
Description
Z23
Encounter for Immunization

IMPORTANT SAFETY INFORMATION


  • FLUMIST QUADRIVALENT is contraindicated in persons who have had a severe allergic reaction (eg, anaphylaxis) to any vaccine component, including egg protein, or after a previous dose of any influenza vaccine, and in children and adolescents receiving concomitant aspirin or aspirin-containing therapy
  • In clinical trials, the risks of hospitalization and wheezing were increased in children <24 months of age who received trivalent FluMist
  • Children <5 years of age with recurrent wheezing and persons of any age with asthma may be at increased risk of wheezing following FLUMIST QUADRIVALENT administration. FLUMIST QUADRIVALENT has not been studied in persons with severe asthma or active wheezing
  • If Guillain-Barré syndrome has occurred within 6 weeks of any prior influenza vaccination, the decision to give FLUMIST QUADRIVALENT should be based on careful consideration of the potential benefits and risks
  • FLUMIST QUADRIVALENT has not been studied in immunocompromised persons
  • The safety of FLUMIST QUADRIVALENT in individuals with underlying medical conditions predisposing them to wild-type influenza infection complications has not been established
  • Appropriate medical treatment and supervision must be available to manage possible anaphylactic reactions following administration of the vaccine
  • FLUMIST QUADRIVALENT may not protect all individuals receiving the vaccine
  • The most common solicited adverse reactions (occurring ≥10% in vaccine recipients and at least 5% greater than in placebo) reported were runny nose or nasal congestion in persons 2-49 years, fever >100°F in children 2-6 years, and sore throat in adults 18-49 years. Among children 2-17 years who received FLUMIST QUADRIVALENT, 32% reported runny nose or nasal congestion and 7% reported fever >100°F. Among adults 18-49 years who received FLUMIST QUADRIVALENT, 44% reported runny nose or nasal congestion and 19% reported sore throat

FLUMIST QUADRIVALENT is a vaccine indicated for active immunization of persons 2-49 years of age for the prevention of influenza disease caused by influenza A subtype viruses and type B viruses contained in the vaccine. FLUMIST QUADRIVALENT is for intranasal administration only.

Please see full Prescribing Information for FLUMIST QUADRIVALENT, including Patient Information.

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