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CMS Transmittals




Q2036
Quick jump to procedure code: Printer Friendly Version
Q2038

Procedure Category: HCPC Level II Codes
Procedure Subcategory: Temporary Codes

Q2037: Fluvirin vacc, 3 yrs & >, im

HCPCS
Q2037: Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (fluvirin)


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2018 Medicare Reimbursement Information         Hide this section.

Unadjusted-National Fee Schedule Amount
ALABAMA-Entire State
ALASKA-Entire State
ARIZONA-Entire State
ARKANSAS-Entire State
CALIFORNIA NORTH-Napa
CALIFORNIA NORTH-San Francisco
CALIFORNIA NORTH-San Mateo
CALIFORNIA NORTH-Oakland/Berkeley
CALIFORNIA NORTH-Santa Clara
CALIFORNIA NORTH-Yuba City
CALIFORNIA NORTH-San Francisco/Oakland/Hayward (Marin County)
CALIFORNIA NORTH-Vallejo/Fairfield
CALIFORNIA NORTH-Bakersfield
CALIFORNIA NORTH-Chico
CALIFORNIA NORTH-Fresno
CALIFORNIA NORTH-Hanford/Corcoran
CALIFORNIA NORTH-Madera
CALIFORNIA NORTH-Merced
CALIFORNIA NORTH-Modesto
CALIFORNIA NORTH-Redding
CALIFORNIA NORTH-Riverside/San Bernardino/Ontario
CALIFORNIA NORTH-Sacramento/Roseville/Arden/Arcade
CALIFORNIA NORTH-Salinas
CALIFORNIA NORTH-San Jose/Sunnyvale/Santa Clara (San Benito County)
CALIFORNIA NORTH-Santa Cruz/Watsonville
CALIFORNIA NORTH-Santa Rosa
CALIFORNIA NORTH-Stockton/Lodi
CALIFORNIA NORTH-Visalia/Porterville
CALIFORNIA SOUTH-Ventura
CALIFORNIA SOUTH-Los Angeles
CALIFORNIA SOUTH-Anaheim/Santa Ana
CALIFORNIA SOUTH-El Centro
CALIFORNIA SOUTH-San Diego/Carlsbad
CALIFORNIA SOUTH-San Luis Obispo/Paso Robles/Arroyo Grande
CALIFORNIA SOUTH-Santa Maria/Santa Barbara
COLORADO-Entire State
CONNECTICUT-Entire State
DELAWARE-Entire State
DIST of COL-DC + MD/VA Suburbs
FLORIDA-Ft Lauderdale
FLORIDA-Miami
FLORIDA-Rest of Florida
GEORGIA-Atlanta
GEORGIA-Rest of Georgia
HAWAII/GUAM-Entire State/Terr.
IDAHO-Entire State
ILLINOIS-East St. Louis
ILLINOIS-Suburban Chicago
ILLINOIS-Chicago
ILLINOIS-Rest of Illinois
INDIANA-Entire State
IOWA-Entire State
KANSAS-Entire State
KENTUCKY-Entire State
LOUISIANA-New Orleans
LOUISIANA-Rest of Louisiana
MAINE-Southern Maine
MAINE-Rest of Maine
MARYLAND-Baltimore and suburbs
MARYLAND-Rest of Maryland
MASSACHUSETTS-Boston
MASSACHUSETTS-Rest of Massachusetts
MICHIGAN-Detroit
MICHIGAN-Rest of Michigan
MINNESOTA-Entire State
MISSISSIPPI-Entire State
MISSOURI-Kansas City
MISSOURI-St. Louis
MISSOURI-Rest of Missouri
MONTANA-Entire State
NEBRASKA-Entire State
NEVADA-Entire State
NEW HAMPSHIRE-Entire State
NEW JERSEY-Northern NJ
NEW JERSEY-Rest of New Jersey
NEW MEXICO-Entire State
NEW YORK-Manhattan
NEW YORK-NYC Suburbs/LI
NEW YORK-Poughkpsie/No NYC Sub
NEW YORK-Rest of New York
NEW YORK-Queens
NORTH CAROLINA-Entire State
NORTH DAKOTA-Entire State
OHIO-Entire State
OKLAHOMA-Entire State
OREGON-Portland
OREGON-Rest of Oregon
PENNSYLVANIA-Philadelphia
PENNSYLVANIA-Rest of Pennsylvania
PUERTO RICO-Entire Territory
RHODE ISLAND-Entire State
SOUTH CAROLINA-Entire State
SOUTH DAKOTA-Entire State
TENNESSEE-Entire State
TEXAS-Brazoria
TEXAS-Dallas
TEXAS-Galveston
TEXAS-Houston
TEXAS-Beaumont
TEXAS-Fort Worth
TEXAS-Austin
TEXAS-Rest of Texas
UTAH-Entire State
VERMONT-Entire State
VIRGIN ISLANDS-Entire State
VIRGINIA-Entire State
WASHINGTON-Seattle (King County)
WASHINGTON-Rest of Washington
WEST VIRGINIA-Entire State
WISCONSIN-Entire State
WYOMING-Entire State


2018 OPPS Status Indicator: L

Effective April 1, 2013, and while sequestration is in effect, all CMS payments for services will be reduced by 2%. The fees above do not reflect this reduction. Click here for more information.

Commonly Associated Diagnosis Codes*            Hide this section.
Percentage
ICD-10 Code
Description
Related DRG(s)
96.4%
Z23
Encounter for immunization
795
951
0.8%
I10
Essential (primary) hypertension
304-305
0.2%
E11.9
Type 2 diabetes mellitus without complications
008
010
637-639
0.1%
Z28.3
Underimmunization status
951
0.1%
Z00.00
Encounter for general adult medical examination without abnormal findings
951
0.1%
I25.10
Atherosclerotic heart disease of native coronary artery without angina pectoris
302-303
0.1%
E03.9
Hypothyroidism, unspecified
643-645
0.1%
J44.9
Chronic obstructive pulmonary disease, unspecified
190-192
0.1%
E11.65
Type 2 diabetes mellitus with hyperglycemia
008
010
637-639
0.1%
M54.5
Low back pain
551-552

* Commonly Associated ICD-10 codes derived from CMS Q3 2016 Limited Data Set (LDS) claims data.
This data represents an analysis of 11,119,991 claims processed for 1,414,138 beneficiaries in the third quarter of 2016.

Medicare Coverage Policy Information         Hide this section.
No contractor selected.

Q2037 not found in an Local Coverage Determination (LCD) for your contractor. No other coverage policies found in database.

CCI and MUE Edits*         Hide this section.

Multiple Code CCI/MUE Edit Report-New

Column 1 CCI Edits for Q2037
Denied Codes (1)
Effective
Modifier
Accepted (2)
90654 FLU VACC IIV3 NO PRESERV ID
07/01/2011 No
90655 IIV3 VACC NO PRSV 0.25 ML IM
07/01/2011 No
90656 IIV3 VACC NO PRSV 0.5 ML IM
07/01/2011 No
90657 IIV3 VACCINE SPLT 0.25 ML IM
07/01/2011 No
90658 IIV3 VACCINE SPLT 0.5 ML IM
07/01/2011 No
90660 LAIV3 VACCINE INTRANASAL
07/01/2011 No
90661 CCIIV3 VAC NO PRSV 0.5 ML IM
07/01/2011 No
90662 IIV NO PRSV INCREASED AG IM
07/01/2011 No
90664 LAIV VACC PANDEMIC INTRANASL
10/01/2015 Yes
90666 FLU VAC PANDEM PRSRV FREE IM
10/01/2015 Yes
90667 IIV VACC PANDEMIC ADJUVT IM
10/01/2015 Yes
 
Denied Codes (1)
Effective
Modifier
Accepted (2)
90668 IIV VACCINE PANDEMIC IM
10/01/2015 Yes
90673 RIV3 VACCINE NO PRESERV IM
01/01/2014 No
90685 IIV4 VACC NO PRSV 0.25 ML IM
07/01/2013 No
90686 IIV4 VACC NO PRSV 0.5 ML IM
07/01/2013 No
90687 IIV4 VACCINE SPLT 0.25 ML IM
07/01/2013 No
90688 IIV4 VACCINE SPLT 0.5 ML IM
07/01/2013 No
90689 VACC IIV4 NO PRSRV 0.25ML IM
01/01/2019 No
Q2034 Agriflu vaccine
07/01/2013 No
Q2038 Fluzone vacc, 3 yrs & >, im
07/01/2011 No
Q2039 Influenza virus vaccine, nos
07/01/2011 No
(1) These codes will be denied when submitted for payment on the same date of service as Q2037.

(2) "Yes" indicates that the use of a modifier with the denied code will overcome the edit and allow payment.
"No" indicates that the second code will always be denied.



Column 2 CCI Edits for Q2037

Denied Codes (1)
Effective
Modifier
Accepted (2)
90630 FLU VACC IIV4 NO PRESERV ID
01/01/2015 No
90653 IIV ADJUVANT VACCINE IM
10/01/2015 No
90672 LAIV4 VACCINE INTRANASAL
10/01/2015 No
90674 CCIIV4 VAC NO PRSV 0.5 ML IM
01/01/2017 No
 
Denied Codes (1)
Effective
Modifier
Accepted (2)
90682 RIV4 VACC RECOMBINANT DNA IM
01/01/2017 No
90756 CCIIV4 VACC ABX FREE IM
01/01/2018 No
Q2035 Afluria vacc, 3 yrs & >, im
07/01/2011 No
Q2036 Flulaval vacc, 3 yrs & >, im
07/01/2011 No
(1) These codes will be denied when submitted for payment on the same date of service as Q2037.

(2) "Yes" indicates that the use of a modifier with the denied code will overcome the edit and allow payment.
"No" indicates that the second code will always be denied.


2018 Medically Unlikely Edits for Q2037


Practitioner
Hospital Outpatient
DME Supplier
Allowed Frequency per Day: 1 1 Not Listed
Adjudication Indicator: 2 Date of Service Edit: Policy 2 Date of Service Edit: Policy Not Listed
Rationale: Nature of Service/Procedure Nature of Service/Procedure Not Listed

* CCI Source Data: Practitioner P2P Coding Edits. For more information on these edits or to view the Hospital Outpatient Edits, please visit https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/NCCI-Coding-Edits.html

MUE Source Data: For more information on these edits, please visit href='https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/MUE.html

The responsibility for the content of any "National Correct Coding Policy" included in this product is with the Centers for Medicare and Medicaid Services and no endorsement by the AMA is intended or should be implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, nonuse, or interpretation of information contained in this product.



   Q2037 Top 5 Ordering Providers National* - Extended NPI Market Analysis Search
JAMES LIN -ERIE,PA 1,438
STEPHEN WOODRUFF -JONESBORO,AR 971
MARK EPSTEIN -BINGHAMTON,NY 840
YOUNG-JIK LEE -LOS ANGELES,CA 764
KULDIP GILL -GRASS VALLEY,CA 677

   Q2037 Top 5 Ordering Organizations National*
MAXIM HEALTH SYSTEMS, LLC-MD 16,057
WALGREEN CO-CO 13,155
MAXIM HEALTH SYSTEMS, LLC-MD 11,689
MAXIM HEALTH SYSTEMS, LLC-MD 11,572
MAXIM HEALTH SYSTEMS, LLC-MD 10,042

*Based on 2016 Medicare Fee-For Service Provider Utilization & Payment Data, Physician and Other Supplier, Public Use File



   Medicare Part B Utilization Data for Q2037*         Hide this section.



Annual Performed / Denied


Total National Services (all modifiers) Submitted 2017: 564,438
Total Services Denied 2017: 26,959 (4.8%)
National Charges Submitted 2017: $ 16,434,117.88
National Charges Allowed 2017: $ 8,924,900.46
National Average (No Modifier) Fee Submitted 2017: $ 29.07
National Average (No Modifier) Fee Allowed 2017: $ 16.60


Top 5 Performing Specialties 2017 Total Services Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Internal medicine 210,034 37.2% $ 34.45 10,545 5.0%
Family practice 138,527 24.5% $ 30.79 7,180 5.2%
Nurse practitioner 25,346 4.5% $ 29.39 1,622 6.4%
Mass Immunization Roster Biller
(eff. 4/1/03)
22,611 4.0% $ 24.86 1,604 7.1%

Top 5 Places of Service 2017 Total Services Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Office 438,184 77.6% $ 32.68 22,620 5.2%
Mass immunizations center (eff. 9/1/97) 112,610 20.0% $ 15.21 2,854 2.5%
Home 4,678 0.8% $ 30.82 346 7.4%
Assisted Living Facility 2,810 0.5% $ 35.42 222 7.9%
Urgent Care Facility (eff. 1/1/03) 1,875 0.3% $ 27.69 164 8.7%

Top 5 Modifiers Submitted 2017 Total Services Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
No Modifier 554,920 98.3% $ 29.07 25,914 4.7%
59 - Distinct Procedural Service 3,748 0.7% $ 35.93 566 15.1%
GA - Advanced Beneficiary Notice (ABN) on File 3,396 0.6% $ 29.09 249 7.3%
GW 608 0.1% $ 26.77 14 2.3%
AQ 442 0.1% $ 27.66 8 1.8%

Click here for more information on Custom CodeMap Medicare Utililation Reports.


*Utilization data is derived from analysis of the Physician Supplier Procedure Summary Master File (PSPSMF) which includes data from all Medicare Part B carriers. This data represents procedure-specific billing data for all physician/supplier services rendered to all Medicare beneficiaries during the calendar year named and processed by the Carriers through the six months of the following year.

Part B charge and utilization data for institutional services (hospital outpatient departments, home health agencies, comprehensive outpatient rehabilitation facilities, end-stage renal disease facilities, and rural health clinics) are processed by Medicare Part A fiscal intermediaries and are not included in this data. Data for services rendered to beneficiaries enrolled in risk-based Health Maintenance Organizations (HMOs) are also not included.

CMS Transmittals Referencing "Q2037"
Issue DateTransmittalTitle
2018-08-31 R4124CP Influenza Vaccine Payment Allowances - Annual Update for 2018-2019 Season
2017-11-03 R3908CP Influenza Vaccine Payment Allowances - Annual Update for 2017-2018 Season


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12/10/2018 04:07:40 18.212.93.234

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