Novitas Won’t Pay for Agriflu Flu Vaccine

If you have leftover supplies of last season’s Agriflu influenza vaccine, you might reconsider using it to vaccinate Medicare patients, even though it has a good shelf life. That’s because you won’t get paid for it.

Novitas Solutions, the Medicare payment contractor of Texas as of Nov. 19,  says it will deny claims reporting HCPCS code Q2034 (Agriflu) because Agriflu has not received Federal Drug Administration (FDA) approval for the 2012-13 season.  

In a response to an inquiry from Novitas, the Centers for Medicare & Medicaid Services (CMS) said although no national policy prohibits using a prior year’s vaccine, doing so is not reasonable and necessary. Last year’s Agriflu may not be effective for this year’s flu virus.

Q2034 is one of two codes CMS left to contractors to price in its annual update (PDF) of flu vaccine payment allowances for 2012-13 season (The other is Q2039 — Flu Vaccine Adult, Not Otherwise Classified). “Because Agriflu has not received FDA approval for 2012-2013 season, and because using a vaccine directed against last year’s virus would not be reasonable and necessary, Novitas Solutions will deny claims reporting HCPCS code Q2034,” Novitas said in its Nov. 7 Provider Bulletin

If Agriflu receives an approval, the price will appear in the quarterly Medicare Average Sales Price Drug Pricing File.

Published Nov. 15, 2012 

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June 01, 2016