Flu vaccine pricing for 2025–2026 season now available
CMS released the payment allowances for the 2025–2026 influenza season, which kicked off on August 1 and ends on July 31, 2026. The recommended shots named in the update include the Fluzone high-dose trivalent inactivated, Flublok trivalent recombinant, and Fluad trivalent adjuvanted inactivated flu vaccines.
Part B payment for seasonal flu vaccines is based on 95% of the average wholesale price. However, when the vaccine is furnished in a hospital outpatient department, rural health clinic, or federally qualified health center, payment is based on reasonable cost.
The Current Procedural Terminology (CPT®) codes and payment allowances for the 2025–2026 season are as follows:
- 90653, 90662, and 90673: $98.160
- 90656: $23.215
- 90657: $11.034
- 90658: $22.069
- 90660: $29.714
- 90661: $49.495
Along with the appropriate CPT code, flu vaccine claims should have the appropriate administration and diagnosis codes. Healthcare Common Procedure Coding System (HCPCS) code G0008 is used to report the administration of the flu vaccine to Part B patients, and ICD-10-CM code Z23 is used to report immunization encounters.
Part B covers one flu shot per season per beneficiary, so patients can receive two of these vaccines in one calendar year (CY) if they are administered during different flu seasons. All facilities that administer the flu shot must accept assignment, which means the patient would not be subject to copayments, coinsurance, or deductibles.
In 2024, CMS began offering an additional payment to providers for administering flu, hepatitis B, and pneumococcal vaccines in the home to Medicare beneficiaries. This payment is made in addition to the standard administration amount of approximately $34. Several requirements and criteria must be met to qualify for this add-on payment. For example, the patient must have a condition that restricts their ability to leave their home without support. The additional payment for CY 2025 is approximately $40, but it is geographically adjusted based on where the vaccine is administered. HCPCS code M0201 is used to report in-home flu vaccine administration.
Revenue integrity professionals can read Medicare Claims Processing Transmittal 13349 for more information on the 2025–2026 payment allowances, as well as Chapter 18 of the Medicare Claims Processing Manual for additional preventive vaccine billing guidance.