Medicare will not pay for 90658 any longer which you use in order to signify that a physician administered a vaccine with preservatives to a patient over the age of three. This is effective for medical claims and billing with dates of service on or after January 1, 2011 according to MLN Matters article MM7234.
As per new medical billing guidelines, you'll have to bill based on the specific brand name flu vaccine that the physician administers using the following new HCPCS level II code. Q2035 will be for Afluria, Q2036 will be for Flulaval, Q2037 will be for Fluvirin, and Q2038 will be for Fluzone. And if those products are not there, then you'll instead use or documentation doesn’t indicate which product was used, you'll use Q2039.
These new medical coding and billing rules will be making it very important for you to get specific product information on the flu viruses that your clients are using that you'll be able to appropriately capture those with these new Q-codes. And these once again are for Medicare only.
It's important that you not start submitting these new codes just yet even though they are valid. As of October 1, Medicare indicated that its process system would not be able to accept the new codes until about February 7th of 2011.
So, it's easy up until the end of the year. If you vaccinate a Medicare patient between now and the end of the year, you should bill the 90658. Now, after that, you're going to have to hold the medical claim and billing until the carrier is ready to accept the Q-codes after January 1. So between that January and February time, there could be some difficulty in getting payment immediately for these codes.
For complete and up to date information on family practice coding and billing, visit family practice coding and billing page.