Back to Preventive Services Home Page
Medicare covers flu, pneumococcal, and Hepatitis B shots. Flu, pneumococcal infections, and Hepatitis B can be life threatening to an older person. All people 65 and older should get flu and pneumococcal shots. People with Medicare who are under 65 should also get a flu shot. This is especially important for those who have chronic illness, including heart disease, lung disease, diabetes, or End-Stage Renal Disease (ESRD) (permanent kidney failure requiring dialysis or a kidney transplant).
90630 – Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, for intradermal use
90653 – Influenza vaccine, inactivated, subunit, adjuvanted, for intramuscular use
90654 – Influenza virus vaccine, split virus, preservative-free, for intradermal use
90655 – Influenza virus vaccine, trivalent, split virus, preservative free, when administered to children 6–35 months of age, for intramuscular use
90656 – Influenza virus vaccine, trivalent, split virus, preservative free, when administered to individuals 3 years and older, for intramuscular use
90657 – Influenza virus vaccine, trivalent, split virus, when administered to children 6–35 months of age, for intramuscular use
90658 – Influenza virus vaccine, trivalent (IIV3), split virus, 0.5 mL dosage, for intramuscular use
90660 – Influenza virus vaccine, trivalent, 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
90672 – Influenza virus vaccine, quadrivalent, live, for intranasal use
90673 – Influenza virus vaccine, trivalent, derived from recombinant DNA (RIV3), hemagglutinin (HA) protein only, preservative and antibiotic free, for intramuscular use
90674 – Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage, for intramuscular use
90682 – Influenza virus vaccine, quadrivalent (RIV4), derived from recombinant DNA, 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
90756 – Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, antibiotic free, 0.5 mL dosage, for intramuscular use (Effective for dates of service on or after January 1, 2018, see the Quarterly Influenza Virus Vaccine Code Update – January 2018)
Q2034 – Influenza virus vaccine, split virus, for intramuscular use (Agriflu)
Q2035 – Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Afluria)
Q2036 – Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Flulaval)
Q2037 – Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Fluvirin)
Q2038 – Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Fluzone)
Q2039 – Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (not otherwise specified) (Effective for dates of service from August 1, 2017, through December 31, 2017; replaced by 90756 effective January 1, 2018, see the Quarterly Influenza Virus Vaccine Code Update – January 2018)
G0008 – Administration of influenza virus vaccine
Report one of the following codes:
All Medicare beneficiaries
Once per influenza season
Medicare covers additional flu shots if medically necessary
Does the Medicare Part B deductible or coinsurance/copayment apply for Part B-covered immunizations?
No, neither the Part B deductible nor coinsurance or copayment applies to the vaccines or their administration from physicians or suppliers that agree to accept assignment.
If a beneficiary gets a seasonal influenza virus vaccine more than once in a 12-month period, will Medicare still pay for it?
Yes, Medicare pays for one seasonal influenza virus vaccination per influenza season; however, a beneficiary could get the seasonal influenza virus vaccine twice in a calendar year for two different influenza seasons, and Medicare would pay the provider for each. For example, a beneficiary could get a seasonal influenza virus vaccination in January 2014 for the 2013–2014 influenza season and another seasonal influenza virus vaccination in November 2014 for the 2014–2015 influenza season, and Medicare would pay for both vaccinations.
What is a mass immunizer?
A mass immunizer offers seasonal influenza virus and/or pneumococcal vaccinations to a large number of individuals. A mass immunizer may be a traditional Medicare provider or supplier or a non-traditional provider or supplier (such as a senior citizens’ center, a public health clinic, or a community pharmacy). Mass immunizers must submit claims for immunizations on roster bills and must accept assignment on both the vaccine and its administration. A mass immunizer should enroll with the Medicare Administrative Contractor (MAC) prior to each influenza season. Please see the next question for more enrollment information.
Do providers that only provide immunizations need to enroll in the Medicare Program?
Yes, providers must enroll in the Medicare Program even if immunizations are the only service they will provide to beneficiaries. They should enroll as provider specialty type 73, Mass Immunization Roster Biller, by completing Form CMS-855I for individuals or Form CMS-855B for a group. To locate these forms, visit http://www.cms.gov/Medicare/Provider-Enrollment-andCertification/MedicareProviderSupEnroll on the CMS website. New providers must first receive a National Provider Identifier (NPI) prior to enrollment. For NPI enrollment information, visit https://nppes.cms.hhs.gov/NPPES/Welcome.do on the cms website.
Back to Preventive Services Home Page