Billing Errors on 2024/2025 Influenza Season Claims

The influenza season runs from August 1st of each year until July 31st the following year. Every influenza vaccine is assigned a new NDC each season. This season, some codes no longer have a published fee from CMS. When this occurs, National Government Services will manually price the claims until a fee is established.

We are receiving large volumes of claims with the incorrect NDC or the wrong code based on the NDC for the influenza vaccine for the 2024-2025 flu season. If you receive a billing error denial for the last or the current flu season, please verify the correct NDC and/or CPT is being used. Failure to use the correct CPT/NDC combination and/or using the incorrect flu season NDC will result in a billing error denial. If you find an error, please correct and resubmit the claim.

2024/2025 codes without a fee schedule from CMS are: 90672, 90674, 90682, 90686, 90687, 90688, 90694 and 90756. Visit CMS’ Vaccine Pricing web page for listed fees.

As a reminder, be sure you are using the correct administration code of G0008 for the influenza vaccine. G0008 must be used as it is not subject to the deductible and coinsurance.  Do not use 90471/90472 for the administration of the influenza vaccine.

Posted 9/19/2024