There has been confusion regarding the correct CPT code to use for FluMist for this season (2010-2011). Use CPT code 90660. Here is the response we just received (AAP and AMA). RESPONSE: The AAP pressed the AMA's Vaccine Coding Caucus (VCC) regarding clarification of these issues and we have finally heard back. A formal response will be forthcoming on the AMA website (a link from the AAP site will be provided to the AMA site) after the VCC has reviewed everything and approved it. The main issue is that the seasonal influenza serum is being manufactured with the 2009 H1N1 Virus and other related viruses as well as the fact that CPT recently released new pandemic influenza serum codes.

Here is what we know:

  • CPT codes 90663 (H1N1 serum) and 90470 (H1N1 administration) should not be used in the upcoming months unless you still have some unexpired doses from last season OR there is a need for the manufacturers to make a vaccine specific to the H1N1 virus (which is currently not being done).

  • The new vaccine serum codes related to the influenza pandemic formulation:
    90664- Influenza virus vaccine, pandemic formulation, live, for intranasal
    90666- Influenza virus vaccine, pandemic formulation, split virus, preservative free, intramuscular use (3+yrs)
    90667- Influenza virus vaccine, pandemic formulation, split virus, adjuvanted for intramuscular use (6-35 mnths)
    90668- Influenza virus vaccine, pandemic formulation, split virus, for intramuscular use (3+ years)
    were accepted by the CPT Panel and became effective on July 1, 2010, however, these codes are still FDA pending and will only be used if new pandemic formulations of a particular strain have to be developed. These codes should NOT be used in replace of the current seasonal vaccine serum codes we have in place now. Therefore unless something changes, you will NOT use these codes for the upcoming influenza season.

  • So what will you report? You will continue to report the seasonal serum codes, even though the seasonal vaccine developed for the upcoming flu season will incorporate the 2009 H1N1 virus, as well as related viruses (eg, A/Perth/16/2009 (H3N2)-like virus and a B/Brisbane/60/2008-like virus).
    90655- Influenza virus vaccine, split virus, preservative free, when administered to children 6-35 months, for intramuscular use
    90656- Influenza virus vaccine, split virus, preservative free, when administered to individuals 3 years and older, for intramuscular use
    90657- Influenza virus vaccine, split virus, when administered to children 6-35 months, for intramuscular use
    90658- Influenza virus vaccine, split virus, when administered to individuals 3 years ad older, for intramuscular use
    90660- Influenza virus vaccine, live, for intranasal use

Please forward any further questions directly to the AAP’s Coding Hotline aapcodinghotline@aap.org Thanks!

The AAP Coding Hotline is not intended as a substitute for legal advice, but rather is offered as a resource to assist in accurate coding of patient services. In addition, the AAP is not able to verify the accuracy of the facts relating to the patient encounter that you have described in presenting your coding inquiry. For these reasons, we cannot be held responsible for any coding decisions that you make based on the guidance you receive from the AAP Coding Hotline. It is your responsibility to code for only what you do during a patient encounter. For legal advice related to reporting services under the Health Insurance Portability Accountability Act (HIPAA), contact a qualified health care attorney.

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