Reimbursement FAQs: Some commonly held misunderstandings about reimbursement are clarified.
What vaccine codes have changed under the revised 2013 Current Procedural Terminology (CPT) code set?
- By BSTQ Staff
Since the CPT’s universal adoption in 1983, the American Medical Association makes changes on an annual basis to the CPT code sets under contract with the Centers for Medicare and Medicaid Services (CMS). Code changes affect all provider types that provide CPT professional services in all states.
The newest changes were effective Jan. 1, 2013, and are mandatory, as noncompliance is a HIPAA violation. The switch to the new codes is based on the date of service, not the date the claim was submitted. For dates of service prior to January 1, providers can bill with the old codes. CMS does not allow for a transition period; providers must bill with new CPT codes on January 1 for dates of service on or after January 1. This includes electronic claims.
Several additions and changes have been made to flu vaccine and other vaccine codes for 2013. One new code, 90653, was added for influenza vaccine, inactivated, subunit, adjuvanted, for intramuscular use. Code 90653 appears in the CPT codebook with the U.S. Food and Drug Administration (FDA) approval pending symbol. The administration of the vaccine is separately reported using Immunization Administration Vaccines/Toxoids codes 90460-90474.
Four influenza virus vaccine product codes have been revised to specify “trivalent” to prepare for the new quadrivalent influenza vaccines, which are expected to be available in 2013. These include:
- 90655: influenza virus vaccine, trivalent, split virus, preservative free, when administered to children ages 6 months to 35 months, 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 months to 35 months of age, for intramuscular use; and
- 90658: influenza virus vaccine, trivalent split virus, when administered to individuals 3 years of age and older, for intramuscular use.
Only one quadrivalent flu vaccine code, 90672, was added in the 2013 CPT for a quadrivalent live influenza virus vaccine, which received FDA approval in February 2012. However, the AMA has suggested four more quadrivalent codes, 90685 through 90688, for 2014. Other new vaccine codes include 90739 — hepatitis B vaccine, adult dosage (2- dose schedule, pending FDA approval), for intramuscular use, and 90746 — hepatitis B vaccine, adult dosage (3-dose schedule), for intramuscular use.
The Hib-MenCY vaccine code, 90644, was changed to FDA-approved status. And deletions to the CPT code set include code 90665 for reporting Lyme disease vaccine, as it is no longer available; code 90701 for reporting the whole cell pertussis vaccine composed of whole cells killed Bordetella pertussis bacilli, combined with diphtheria and tetanus toxoids, as it is no longer used in the U.S.; and code 90718 to report preservative containing tetanus and diphtheria (Td) toxoid vaccine, because no Td product currently on the market is considered “preservative-containing.”
Editor’s Note: The content of this column is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.
