Issued by: Centers for Medicare & Medicaid Services (CMS)

Issue Date: August 27, 2020

What’s New for the 2024-2025 Season

All U.S. flu vaccines this season are trivalent (3 virus) vaccines and were updated from last season’s vaccines to provide optimal protection.

Frequency & Coverage

• The CDC recommends annual flu shots for everyone 6 months and older each flu season. September and October are the best times for most people to get vaccinated.
• Medicare Part B covers the seasonal flu shot.
• We cover additional flu shots if medically necessary. Patients can get flu shots twice in a calendar year during 2 different flu seasons, and we’ll pay for both shots.
• Your patients pay nothing if you accept assignment. There’s no copayment, coinsurance, or deductible.
• Find out when your patients are eligible for the flu shot (PDF). We give information for dates of service in the last 18 months:
  • CPT or HCPCS codes
  • Dates of service
  • NPIs who administered the shots

If you need help, contact your eligibility service provider.

Billing

• All providers who administer the flu shot must accept assignment.
• You may use roster billing or submit an individual claim. Learn more about roster billing, mass immunizers, and centralized billing.
• Entities, like local health facilities, must get an NPI (PDF) if they’ve never submitted Medicare claims.
• Starting on January 1, 2024, you may bill for an additional payment for administering the flu vaccine to Medicare patients in their homes under certain circumstances. Learn more about the  In-Home Vaccine Administration: Additional Payment.
• Skilled nursing facility enforcement discretion for pharmacy billing ended on June 30, 2023. 

ICD-10, HCPCS, and CPT codes

ICD-10 Code: Z23

Seasonal HCPCS & CPT codes: Get the most current list of billing codes, payment allowances, and effective dates. 

Additional Resources

• Flu Shot & Administration 
• Preventive Services webpage
• CDC Flu webpage
• Office of Minority Health Immunization and Vaccine Resources webpage
• Annual Influenza Vaccination (PDF) data snapshot: Learn about disparities in Medicare patients
• Manuals:
  • Section 50.4.4.2 Medicare Benefit Policy Manual, Chapter 15 - Covered Medical and Other Health Services (PDF)
  • Section 10 Medicare Claims Processing Manual, Chapter 18 - Preventive and Screening Services (PDF)

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DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.