Does Q2037 require prior authorization?

No, Q2037 does not require prior authorization (high confidence). Covered without prior authorization.

What is the Medicare reimbursement rate for Q2037?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.00.

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`Q2037`, Influenza virus vaccine, split virus, when administered to individuals 3 years

HCPCS/CPT

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation Required

Influenza vaccine claims must contain HCPCS G0008 and diagnosis ICD-10 Z23.
Pneumococcal vaccine claims must contain HCPCS G0009 and diagnosis ICD-10 Z23.

Hepatitis B vaccine claims must contain HCPCS G0010 and diagnosis ICD-10 Z23 and documentation of patient risk status (e.g., ESRD, hemophilia, household contact, sexual/drug-use risk, healthcare worker, institutional resident/staff).

Key Coverage Criteria

COVID-19 vaccines are covered under Medicare Part B (see CMS guidance for vaccine pricing and coding).
Seasonal influenza vaccine is covered once per flu season (use codes 90635, 90637, 90638, 90653-90657, 90660-90662, 90672-90674, 90682, 90685-90689, 90694, 90695, 90756, Q2034-Q2039).
Pneumococcal vaccine is covered as an initial dose for Medicare beneficiaries who have never received a pneumococcal vaccine under Medicare Part B (use codes 90670, 90671, 90677, 90732).
A different, second pneumococcal vaccine is covered when administered at least 1 year after the first pneumococcal vaccine.
Pneumococcal and seasonal influenza vaccines administered during the same visit are both covered (bill seasonal influenza and pneumococcal vaccine codes).
Hepatitis B vaccine is covered only for persons at intermediate-to-high risk (use codes 90739-90740, 90743-90744, 90746-90747, 90759).

2 Active Policies

A54767, Billing and Coding: Medicare Preventive Coverage for Certain Vaccines

CIGNA-A004, Preventive Care Services

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Q2037, Influenza virus vaccine, split virus, when administered to individuals 3 years