tci Medicare Compliance & Reimbursement - 2014 Issue 23

Reader Question: Avoid 90662 for Patients Under 65

Question: We reported 90662 for a patient’s Fluzone shot and it was denied. The insurer said the patient doesn’t meet the age requirements, but we didn’t see any age listed on the code descriptor. Can you advise? Answer: Most MACs will only cover 90662 (Influenza virus vaccine, split virus, preservative free, enhanced immunogenicity via increased antigen content, for intramuscular use) for patients age 65 and older. The higher antigen content offers increased protection to older patients, and this code is considered a high dosage of the Fluzone vaccine because it contains four times the hemagglutinin antigen...

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