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The Medicare Part B payment allowance limits for influenza and pneumococcal vaccines are 95% of the Average Wholesale Price (AWP) as reflected in the published compendia except where the vaccine is furnished in a hospital outpatient department. When the vaccine is furnished in the hospital outpatient department, payment for the vaccine is based on reasonable cost. Annual Part B deductible and coinsurance amounts do not apply for the influenza virus and the pneumococcal vaccinations. All physicians, non-physician practitioners, and suppliers who administer these vaccinations must take assignment on the claim for the vaccine. The prices below reflect the payment allowance for the listed CPT codes when the vaccines are furnished outside the hospital outpatient department. Prices Effective September 1, 2008 CPT 90655: $16.879
CPT 90656: $18.198
CPT 90657: $6.609
CPT 90658: $13.218
CPT 90660: $22.316 Additional information on 2008 Influenza and Pneumococcal Vaccines pricing is available in Change Request (CR) 6153, which is available in the 'Downloads' section below. Prices Effective September 1, 2007 CPT 90655: $16.109
CPT 90656: $17.366
CPT 90657: $6.609
CPT 90658: $13.218
CPT 90732: $29.730
CPT 90669: $78.803
CPT 90660: $21.176 Additional information on 2007 Influenza and Pneumococcal Vaccines pricing is available in CR 5744, which can be obtained via the 'downloads' section below.
Page Last Modified: 11/04/2008 1:20:18 PM
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