FLUMIST® QUADRIVALENT (Influenza Vaccine Live, Intranasal) Coding Resource
Submitting accurate codes and claims is important to ensure proper reimbursement of services. Utilization of current Current Procedural Terminology (CPT) codes may help ensure that your office is up to date with insurance coding practices. Check with specific health plans or call Access 360™ at 1-877-778-9010 to inquire about coding and payer coverage, as timing of adoption of new codes may vary.
Access 360 cannot provide specific reimbursement rates, nor does coding information provided guarantee reimbursement.
The National Drug Code (NDC) identifies drugs by manufacturer, dosage, and package size. Electronic claims require a valid 11-digit NDC or they may be denied.
|11 digit NDC|
|10 digit NDC|
The chart below lists Common Procedural Terminology (CPT) codes for your reference.
FluMist Quadrivalent CPT
||Influenza virus vaccine, quadrivalent, live, for intranasal use
Immunization Administration CPT Codes
||Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified healthcare professional; first or only component of each vaccine or toxoid administered
||Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified healthcare professional; each additional vaccine or toxoid component administered (list separately in addition to code for primary procedure)
According to the American Academy of Pediatrics, codes 90473-90474 are reported for older patients (i.e., those 19 years of age and older) or if there is no counseling performed on the patient, or the healthcare professional counseling does not meet state requirements for “other qualified healthcare professional.” It should also be noted that the following codes are reported per administration.
||Immunization administration by intranasal or oral route; one vaccine (single or combination vaccine/toxoid) (Do not use 90473 in conjunction with 90471)
||Each additional vaccine (single or combination vaccine/toxoid) (List separately in addition to code for primary procedure) (Use 90474 in conjunction with 90471 or 90473)
Important Safety Information for FluMist Quadrivalent
FluMist® Quadrivalent (Influenza Vaccine Live, Intranasal) is a vaccine indicated for active immunization of persons 2-49 years of age for the prevention of influenza disease caused by influenza A subtype viruses and the type B virus contained in the vaccine. FluMist Quadrivalent is for intranasal administration only.
FluMist Quadrivalent is contraindicated in persons who have had a severe allergic reaction to any vaccine component including egg protein, gentamicin, gelatin, and arginine, or after a previous dose of any influenza vaccine, and in children and adolescents receiving concomitant aspirin or aspirin-containing therapy.
In clinical trials, the risks of hospitalization and wheezing were increased in children <2 years of age who received FluMist Quadrivalent. Children <5 years of age with recurrent wheezing and persons of any age with asthma may be at increased risk of wheezing following FluMist Quadrivalent administration. FluMist Quadrivalent has not been studied in persons with severe asthma or active wheezing.
If Guillain-Barré syndrome has occurred within 6 weeks of any prior influenza vaccination, the decision to give FluMist Quadrivalent should be based on careful consideration of the potential benefits and risks. The effectiveness of FluMist Quadrivalent has not been studied in immunocompromised persons. The safety of FluMist Quadrivalent in individuals with underlying medical conditions predisposing them to wild-type influenza infection complications has not been established. FluMist Quadrivalent may not protect all individuals receiving the vaccine.
The most common solicited adverse reactions (occurring at >10% in FluMist Quadrivalent recipients and at least 5% greater than in placebo recipients) were runny nose or nasal congestion in recipients of all persons 2-49 years, fever >100°F in children 2-6 years, and sore throat in adults 18-49 years.
Please see accompanying complete Prescribing Information for FluMist Quadrivalent, including Patient Information.