Last week, CMS said that it would hold claims for CPT code 90658 for dates of service on or after Aug. 1 through Oct. 7. CMS said that the Medicare Administrative Contractors will reprocess any denied claims by Nov. 1, with no claimant action required.
In addition, it appears 2024 rates for Medicare Part B influenza and COVID-19 vaccines may not have been loaded by all MACs yet. Some MACs may be holding claims until new rates are loaded, some may be rejecting, some may be paying the administration fee and holding the claim for the product. We’ve heard it all!
However, be aware that we know of at least one code for influenza that remained the same as last year, CPT code 90662 Fluzone High-Dose Quadrivalent. If submitted, some MACs are processing claims at the 2023 rates ($73.403 instead of $83.492). All codes for COVID remained the same as last year. We would suggest you work with your medical billing intermediary for guidance on how to handle these claims.
For your convenience, here is the CMS notice in full:
Influenza Vaccine: Holding Claims for CPT Code 90658
CMS is aware of an issue affecting payment for CPT code 90658:
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Long descriptor: Influenza virus vaccine, trivalent (IIV3), split virus, 0.5 mL dosage, for intramuscular use
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Short descriptor: IIV3 VACCINE SPLT 0.5 ML IM
We’re holding claims for CPT code 90658 for dates of service on or after August 1, 2024, until October 7, 2024.
Your Medicare Administrative Contractor will reprocess any denied claims by November 1, 2024. You don’t need to take any action.
The notice is available on the CMS website here.
