CODING GUIDE BILLING AND - 2019-2020 INFLUENZA SEASON - Seqirus
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BILLING AND CODING GUIDE 2019-2020 INFLUENZA SEASON Please see Important Safety Information on pages 6-8 and 13, and accompanying full Prescribing Information.
Coding for all THE GRID BELOW EXPLAINS HOW TO CODE FOR SEQIRUS VACCINES¹-4
Seqirus vaccines
Seqirus Vaccine 2019-2020 2019-2020 NDC Presentation/ Age Vaccine Product
Because there are many Current Product Description NDC Carton Unit-of-Use Dose Indication Billing Code
Procedural Terminology (CPT )
codes that describe influenza CPT/Medicare Code
vaccines, accurate coding for
influenza vaccines is critical. FLUAD® (influenza 70461-019-03 70461-019-04 Prefilled 65 years 90653
You must code correctly based vaccine, adjuvanted) syringe 0.5 mL and older
on the product you are using to
90653 = Influenza vaccine, inactivated (IIV), subunit, adjuvanted, for intramuscular use
receive accurate payment.
FLUCELVAX® 70461-319-03 70461-319-04 Prefilled syringe 4 years 90674
QUADRIVALENT 0.5 mL and older
(influenza vaccine)
70461-419-10 70461-419-11 Multidose vial 4 years 90756
5 mL and older
90674 = Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, preservative- and antibiotic-free,
0.5 mL dosage, for intramuscular use
90756 = Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, antibiotic free, 0.5 mL dosage,
for intramuscular usea
33332-219-20 33332-219-21 Prefilled syringe 6 through 90685
0.25 mL 35 months
AFLURIA® 33332-319-01 33332-319-02 Prefilled syringe 36 months 90686
QUADRIVALENT 0.5 mL and older
(influenza vaccine)
33332-419-10 33332-419-11 Multidose viala 6 through 90687 (0.25 mL dose)
35 months
5 mL
36 months 90688 (0.5 mL dose)
and older
90685 = influenza vaccine, quadrivalent (IIV4), split virus, preservative-free, 0.25 mL dosage, for intramuscular use
90686 = Influenza vaccine, quadrivalent (IIV4), split virus, preservative-free, 0.5 mL dosage, for intramuscular use
90687 = influenza vaccine, quadrivalent (IIV4), split virus, 0.25 mL dosage, for intramuscular use
90688 = Influenza vaccine, quadrivalent (IIV4), split virus, 0.5 mL dosage, for intramuscular use
NDC=National Drug Code.
a
No more than 10 doses (0.25 mL or 0.5 mL) should be withdrawn from the Afluria Quadrivalent multidose vial.
Please see Important Safety Information on pages 6-8 and 13,
and accompanying full Prescribing Information.National Drug Codes change each year
for influenza vaccines
The National Drug Codes (NDCs) for 2019-2020 Seqirus vaccines are listed in the grid to the left. Some Medicaid agencies and
private health plans require the use of an 11-digit NDC in addition to the CPT code on claims for physician-administered products.
However, Medicare and TriCare require both the current NDC and CPT code for billing influenza vaccines (eg, Fluad-70461-0019-03;
the red shows where the additional zero needs to be added and is the same for all of our vaccines). Influenza vaccines are licensed
each year with new NDCs, so it is important to report the correct code for the product you are using. Additionally, the US Food and
Drug Administration (FDA) requires different NDCs on the cartons and the syringe or vial (unit-of-use), so it is important to record the
correct NDC in the patient’s record as per the standard procedure in your practice. For billing/claims processing for Seqirus influenza
vaccines, the NDC from the carton should be used. If you have questions, call your payers to confirm their preferred NDC, either
carton or unit-of-use.
DISCLAIMER: The billing and coding information contained in this document is presented as a resource and guide to billing and coding for AFLURIA
QUADRIVALENT (Influenza Vaccine), FLUCELVAX QUADRIVALENT (Influenza Vaccine), FLUAD (Influenza Vaccine, Adjuvanted), plus antiviral
treatment RAPIVAB® (peramivir injection). Billing and coding information is gathered from several sources and is subject to change without notice. While
every effort is made to ensure the accuracy of this information, appropriate billing and coding for health care services are the provider’s responsibility and
should always be based on the patient’s clinical condition, services provided, and payer guidelines.
1Coding for the administration HCPCS Code Description
of Seqirus vaccines
The method of administration of Seqirus vaccines should be reported in addition G0008 Seasonal influenza virus vaccine administration
to the vaccine product code. Assign the appropriate immunization administration
code based on the documentation in the medical record. The following CPT codes
are for vaccines administered via injection to individuals.5
Influenza vaccine International Classification
CPT Code Description
of Diseases, Tenth Revision diagnosis codes
Below is a suggested International Classification of Diseases, Tenth Revision
(ICD-10) diagnosis code that may be appropriate when submitting claims for
99213 A mid-level outpatient or inpatient office visit.
Seqirus vaccines and their administration. The code should be linked to both
Level 3 code for an established patient (not for
the vaccine and administration codes.5
a new patient who has no history).
Immunization administration through 18 years of ICD-10 Code Description
age via any route of administration with
90460 counseling by physician or other qualified health
care professional; first or only component of each Z23 Encounter for immunization
vaccine or toxoid administered
90471 Immunization administration, 1 injection
Use of modifiers when billing for vaccines
90472 Immunization administration, each additional Vaccines are usually administered as a preventive service, but may also be
(add-on code) injection administered as a problem-oriented evaluation and management (E/M) service.
When a vaccine is administered and an illness, abnormality, or other problem is
significant enough to require additional work, the modifier "25" should be attached
Medicare requires use of Healthcare Common Procedure Coding System (HCPCS) to the office or other outpatient service code to indicate which E/M service was
codes for the administration of the vaccines that they cover preventively, including provided by the same physician on the same day as the preventive medicine
influenza vaccine. HCPCS code G0008 must be used when billing Medicare for service. Check with your payers to understand their coding requirements regarding
the administration of Seqirus vaccines, regardless of patient age or provider use of the 25 modifier.5,7
counseling. Some payers, including Medicare, may require that an HCPCS code be
used instead of a CPT code to report the administration of influenza vaccines. See
For any reimbursement-related questions, customers may also call the
the grid below for more information on this code.6
Seqirus Customer Service Center at 855.358.8966, option #3.
Please see Important Safety Information on pages 6-8 and 13,
and accompanying full Prescribing Information.
2FLUAD® (Influenza Vaccine, Adjuvanted)
administered to a patient on Medicare
A 67-year-old man is seen at an urgent care facility after a fall.
The physician recommends that he also receive an influenza
vaccine and administers FLUAD. 1,3,5,7-9
Z23 = encounter for immunization
R29.6 = repeated falls
99281 = ER evaluation
and management
90653 = FLUAD
G0008 = administration
3FLUCELVAX® QUADRIVALENT (Influenza Vaccine)
administered at a problem-focused visit
A 34-year-old woman is seen at the physician’s office for evaluation
of her asthmatic condition and related prescription refills. The physician
recommends she receive an influenza vaccine and administers
FLUCELVAX QUADRIVALENT. 1,4,5,7,9
J45.40 = moderate persistent
asthma, uncomplicated
Z23 = encounter for immunization
99212 = established outpatient
90674 = FLUCELVAX QUADRIVALENT
90471 = administration
Please see Important Safety Information on pages 6-8 and 13,
and accompanying full Prescribing Information.
4AFLURIA® QUADRIVALENT (Influenza Vaccine)
vaccine administered at a well visit
A 28-year-old woman is seen for a well visit and receives a needleless
influenza vaccination, AFLURIA QUADRIVALENT. 1,2,5,7
ICD-10: Z00.00 = encounter for
routine adult health examination
without abnormal findings
Z23 = encounter for immunization
99213 = mid-level outpatient or
inpatient office visit. Level 3 code
for an established patient
25 = modifier (See page 2: Use of
modifiers when billing for vaccines)
99213
90686 90686 = AFLURIA QUADRIVALENT
90471
90471 = administration
5INDICATIONS AND USAGE ADVERSE REACTIONS
FLUAD is an inactivated influenza vaccine indicated for active immunization • The most common (≥10%) local (injection site) adverse reactions observed
against influenza disease caused by influenza virus subtypes A and type B in clinical studies were injection site pain (25%) and tenderness (21%).
contained in the vaccine. FLUAD is approved for use in persons 65 years of age • The most common (≥10%) systemic adverse reactions observed in clinical
and older. studies were myalgia (15%), headache (13%), and fatigue (13%).
IMPORTANT SAFETY INFORMATION To report SUSPECTED ADVERSE REACTIONS, contact Seqirus at
1-855-358-8966 or VAERS at 1-800-822-7967 and www.vaers.hhs.gov.
CONTRAINDICATIONS For more information, please see accompanying US full Prescribing
Severe allergic reaction to any component of the vaccine, including egg protein, Information for FLUAD.
or after a previous dose of any influenza vaccine.
FLUAD® is a registered trademark of Seqirus UK Limited or its affiliates.
WARNINGS AND PRECAUTIONS
• If Guillain-Barré syndrome (GBS) has occurred within six weeks of previous
influenza vaccination, the decision to give FLUAD should be based on careful
consideration of the potential benefits and risks.
Please see Important Safety Information on pages 6-8 and 13,
and accompanying full Prescribing Information.
6INDICATION AND USAGE FOR FLUCELVAX® QUADRIVALENT ADVERSE REACTIONS
(INFLUENZA VACCINE) • The most common (≥10%) local and systemic reactions in adults 18-64 years of
FLUCELVAX QUADRIVALENT is an inactivated vaccine indicated for active age were injection site pain (45.4%), headache (18.7%), fatigue (17.8%), myalgia
immunization for the prevention of influenza disease caused by influenza A subtype (15.4%), injection site erythema (13.4%), and induration (11.6%).
viruses and type B viruses contained in the vaccine. FLUCELVAX QUADRIVALENT • The most common (≥10%) local and systemic reactions in adults ≥65 years
is approved for use in persons 4 years of age and older. of age were injection site pain (21.6%) and injection site erythema (11.9%).
• The most common (≥10%) local and systemic reactions in children 4 toINDICATION • In children 5 through 8 years, the most commonly reported injection-site
AFLURIA QUADRIVALENT is an inactivated influenza vaccine indicated for active adverse reactions when administered by needle and syringe were pain (≥50%),
immunization against influenza disease caused by influenza A subtype viruses and redness and swelling (≥10%). The most common systemic adverse event was
type B viruses contained in the vaccine. AFLURIA QUADRIVALENT is approved for headache (≥10%).
use in individuals 5 years of age and older. • In children 9 through 17 years, the most commonly reported injection-site
adverse reactions when administered by needle and syringe were pain (≥50%),
IMPORTANT SAFETY INFORMATION redness and swelling (≥10%). The most common systemic adverse events were
headache, myalgia, and malaise and fatigue (≥10%).
CONTRAINDICATIONS • In children 6 months through 35 months of age, the most commonly reported
• Severe allergic reactions (e.g., anaphylaxis) to any component of the vaccine injection-site reactions were pain and redness (≥ 20%). The most common systemic
including egg protein, or to a previous dose of any influenza vaccine. adverse events were irritability (≥ 30%), diarrhea and loss of appetite (≥ 20%).
• In children 36 through 59 months of age, the most commonly reported injection
WARNINGS AND PRECAUTIONS site reactions were pain (≥ 30%) and redness (≥ 20%). The most commonly
• If Guillain-Barré Syndrome (GBS) has occurred within 6 weeks of previous reported systemic adverse events were malaise and fatigue, and diarrhea (≥ 10%).
influenza vaccination, the decision to give AFLURIA QUADRIVALENT should be The safety experience with AFLURIA (trivalent formulation) is relevant to AFLURIA
based on careful consideration of the potential benefits and risks. QUADRIVALENT because both vaccines are manufactured using the same
• Appropriate medical treatment and supervision must be available to manage process and have overlapping compositions:
possible anaphylactic reactions following administration of the vaccine. • In adults 18 through 64 years of age, the most commonly reported injection-
• Immunocompromised persons may have a diminished immune response to site adverse reactions with AFLURIA (trivalent formulation) when administered
AFLURIA QUADRIVALENT. by the PharmaJet Stratis Needle-Free Injection System were tenderness
(≥80%), swelling, pain, redness (≥60%), itching (≥20%) and bruising (≥10%).
ADVERSE REACTIONS The most common systemic adverse events were myalgia, malaise (≥30%),
and headache (≥20%).
• In adults 18 through 64 years, the most commonly reported injection-site
adverse reaction when administered by needle and syringe was pain (≥40%). To report SUSPECTED ADVERSE REACTIONS, contact Seqirus USA Inc. at
The most common systemic adverse events were myalgia and headache (≥20%). 1-855-358-8966 or VAERS at 1-800-822-7967 or www.vaers.hhs.gov.
• In adults 65 years of age and older, the most commonly reported injection-site
Please see accompanying full Prescribing Information for AFLURIA
adverse reaction when administered by needle and syringe was pain (≥20%). QUADRIVALENT.
The most common systemic adverse event was myalgia (≥10%).
AFLURIA is a registered trademark of Seqirus UK Limited or its affiliates.
PharmaJet® and STRATIS® are registered trademarks of PharmaJet.
Please see Important Safety Information on pages 6-8 and 13,
and accompanying full Prescribing Information.
8CODING FOR THE ADMINISTRATION OF RAPIVAB
The administration of RAPIVAB should be reported in addition to the treatment
product code. Assign the appropriate administration code based on the
documentation in the medical record. The following CPT codes are for treatments
administered via injection to individuals.7
Coding for Seqirus antiviral influenza CPT Code Description
treatment, RAPIVAB
96365 Intravenous (IV) infusion, for therapy, prophylaxis,
Some payers will require the NDC or diagnosis; initial, up to first hour
to identify RAPIVAB. 10 IV infusion, for therapy, prophylaxis, or diagnosis;
96366
each additional hour
96374 Therapeutic, prophylactic, or diagnostic injection;
Seqirus Product NDC Carton NDC Unit-of-Use Presentation IV push, single or initial substance/drug
Description and Dose
96375 IV med injection—second med subsequent injection
Single-use
RAPIVAB® 96376 IV med injection—first med subsequent injection
61364-181-03 61364-181-01 vial contains
(peramivir
200 mg per
injection)
20 mL
96360 IV hydration—31 min to 1 hour
96361 IV hydration—each additional hour
Medicare requires the use of an HCPCS code for the administration of RAPIVAB.
Some payers may also require that an HCPCS code be used to report RAPIVAB. 11
HCPCS Code Description
J2547 Injection, peramivir, 1 mg
9INFLUENZA TREATMENT ICD-10 DIAGNOSIS CODES
Below are suggested ICD-10 diagnosis codes that may be appropriate when
submitting claims for RAPIVAB and its administration. The code(s) should be linked
to both the product and administration codes. 12
ICD-10 Code Description ICD-10 Code Description
Influenza due to other identified influenza virus Influenza due to other identified influenza
J10.00 with unspecified type of pneumonia J10.83
virus with otitis
Influenza due to other identified influenza virus with Influenza due to other identified influenza virus
J10.01 the same other identified influenza virus pneumonia J10.89 with other manifestations
Influenza due to other identified influenza virus with Influenza due to unidentified influenza virus with
J10.08 other specified pneumonia J11.2 gastrointestinal manifestations
Influenza due to unidentified influenza virus with Influenza due to unidentified influenza virus
J11.00 unspecified type of pneumonia J11.81 with encephalopathy
Influenza due to unidentified influenza virus with Influenza due to unidentified influenza virus
J11.08 specified pneumonia J11.82
with myocarditis
Influenza due to unidentified influenza virus
J12.9 Viral pneumonia, unspecified J11.83
with otitis media
Influenza due to other identified influenza virus with Influenza due to unidentified influenza virus with
J10.1 J11.89
other respiratory manifestations other manifestations
Influenza due to unidentified influenza virus with Influenza due to identified novel influenza A virus
J11.1 other respiratory manifestations J09.X1 with pneumonia
Influenza due to other identified influenza virus Influenza due to identified novel influenza A virus
J10.2 with gastrointestinal manifestations J09.X2 with other respiratory manifestations
Influenza due to other identified influenza virus Influenza due to identified novel influenza A virus
J10.81 with encephalopathy J09.X3
with gastrointestinal manifestations
Influenza due to other identified influenza virus Influenza due to identified novel influenza A virus
J10.82 J09.X9
with myocarditis with other manifestations
Please see Important Safety Information on pages 6-8 and 13,
and accompanying full Prescribing Information.
10INFLUENZA TREATMENT REVENUE CODES EXAMPLES FOR BILLING RAPIVAB
Below are suggested revenue codes that are used to attribute hospital charges RAPIVAB® (peramivir injection) administered
to specific cost centers. Revenue codes vary by service provided and also vary
depending on patient status. 13
at a problem-focused visit in physician's office.
A 23-year-old woman visits an urgent care facility for evaluation of her flu
symptoms. The physician recommends she receive RAPIVAB.7,12
Revenue Code Description
Drugs requiring detailed coding required by
0636 Medicare to obtain pass-through payment for
drugs in the outpatient department
0250 Drugs and biologicals
0260 IV therapy, general J10.2 = influenza due to other
identified influenza virus with
0450 Emergency room gastrointestinal manifestations
0510 Clinic
0520 Free-standing clinic 96365 = IV infusion (CPT code)
11RAPIVAB® (peramivir injection) administered
at a problem-focused visit in a hospital setting
A 71-year-old man visits the emergency room for evaluation of his flu symptoms.
The physician recommends he receive RAPIVAB.7,11-13
Note: Because these services are provided in a hospital setting, a CMS-1450
claim form must be used for proper reimbursement.
0636 = Medicare revenue code
J2547 = HCPCS for Medicare
96365 = IV infusion (CPT code)
J10.00 = influenza due to other
identified influenza virus with
unspecified type of pneumonia
Please see Important Safety Information on pages 6-8 and 13,
and accompanying full Prescribing Information.
12INDICATION appear to be uncommon. These events were reported primarily among pediatric patients.
The contribution of Rapivab to these events has not been established. Patients with
RAPIVAB is indicated for the treatment of acute uncomplicated influenza in patients 2 years
influenza should be closely monitored for signs of abnormal behavior.
and older who have been symptomatic for no more than 2 days.
• Serious bacterial infections may begin with influenza-like symptoms or may coexist with
IMPORTANT SAFETY INFORMATION or occur as complications during the course of influenza. Rapivab has not been shown to
prevent such complications.
LIMITATIONS OF USE ADVERSE REACTIONS
• Efficacy of RAPIVAB is based on clinical trials of naturally occurring influenza in which The most common adverse reaction in adults (18 years of age and older) was diarrhea (8%
the predominant influenza infections were influenza A virus; a limited number of subjects Rapivab vs 7% placebo). Lab abnormalities (incidence ≥2%) occurring more commonly with
infected with influenza B virus were enrolled. Rapivab than placebo were elevated ALT 2.5 times the upper limit of normal (3% vs 2%),
• Influenza viruses change over time. Emergence of resistance substitutions could decrease elevated serum glucose >160 mg/dL (5% vs 3%), elevated CPK at least 6 times the upper limit
drug effectiveness. Other factors (for example, changes in viral virulence) might also diminish of normal (4% vs 2%), and neutrophilsThis influenza season, count on the Seqirus portfolio of influenza products.
3 EASY ORDERING METHODS:
Order online at Contact your Seqirus Email customer
flu.seqirus.com account manager service at
about our portfolio customerservice.us
of influenza vaccines @seqirus.com
and treatment
FOR REIMBURSEMENT SUPPORT CALL 855-358-8966, OPTION #3
References: 1. Influenza vaccine products for 2019-2020 influenza season. Immunization Action Coalition website. http://www.immunize.org. 2. Afluria Quadrivalent [package insert]. Summit, NJ: Seqirus USA Inc; 2019.
3. FLUAD [package insert]. Summit, NJ: Seqirus USA Inc; 2019. 4. FLUCELVAX QUADRIVALENT [package insert]. Summit, NJ: Seqirus USA Inc; 2019. 5. Coding for pediatric preventive care, 2018. American Academy of
Pediatrics website. https://www.aap.org/en-us/Documents/coding_preventive_care.pdf. Published 2019. Accessed October 23, 2019. 6. Medicare part B immunization billing: seasonal influenza virus, pneumococcal, and
hepatitis B. Centers for Medicare and Medicaid Services website. https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/qr_immun_bill.pdf. Published January 2018.
Accessed October 23, 2019. 7. Procedural Coding Expert: The Ultimate Guide to CPT® Coding. Salt Lake City, UT: Contexo Media; 2012. 8. ED facility level coding guidelines. American College of Emergency Physicians
website. https://www.acep.org/administration/reimbursement/ed-facility-level-coding-guidelines/#sm.000005vd05555heczqbvu9txsrjf3. Published 2011. Accessed October 23, 2019. 9. ICD-10-CM tabular list of
diseases and injuries. Centers for Medicare and Medicaid Services website. https://www.cms.gov/Medicare/Coding/ICD10/Downloads/2018-ICD-10-Table-And-Index.zip. Accessed October 23, 2019. 10. Rapivab [package
insert]. Summit, NJ: Seqirus USA Inc; 2018. 11. Parman C. Oncology reimbursement coding update. 2017. Association of Community Cancer Centers website. https://www.accc-cancer.org/publications/pdf/Oncology-
Reimbursement-Coding-Update-2017.pdf. Published 2017. Accessed October 23, 2019. 12. Nelson ME. ICD-10 cometh. CHEST Physician website. http://www.chestnet.org/~/media/chesnetorg/Publications/Documents/
CHEST%20Physician/Vol%2010%202015/0415.ashx. Published April 2015. Accessed October 23, 2019. 13. CMS manual system. Publication 100-04 Medicare claims processing. Centers for Medicare and Medicaid
Services website. https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/r167cp.pdf. Published April 30, 2004. Accessed October 23, 2019.
AFLURIA QUADRIVALENT, FLUAD, FLUCELVAX QUADRIVALENT, and RAPIVAB are registered trademarks of Seqirus UK Limited or its affiliates.
© 2019 Seqirus USA Inc. All rights reserved.
25 Deforest Ave, Summit NJ 07901
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