2025 Influenza and Pneumococcal Vaccines and Administration Reimbursement
The following services are paid at 100 percent of the established fee schedule amount. Coinsurance and the annual deductible do not apply.
- Payment allowances for influenza vaccines are effective August 1, 2024, unless stated otherwise
- Influenza and pneumococcal vaccine payment allowances are subject to change on a quarterly basis*
- Administration payment allowances are updated annually on January 1
*Quarterly changes to influenza and pneumococcal vaccine payment allowances can be located on the CMS website.
Influenza, and Pneumococcal Administration Codes and Fees
Following are the 2024 influenza and pneumococcal administration fees for dates of service January 1, 2024 – December 31, 2024.
Table 1. Influenza, and Pneumococcal Administration Codes and Fees.
|
CPT® Codes |
Description |
N.C. FSY 2025 Amount |
S.C. FSY 2025 Amount |
Va. FSY 2025 Amount |
W.Va. FSY 2025 Amount |
|---|---|---|---|---|---|
| G0008 | Admin influenza virus vac. | $32.09 | $32.13 | $33.17 | $32.06 |
| G0009 | Admin pneumococcal vaccine | $32.09 | $32.13 | $33.17 | $32.06 |
Influenza Virus Vaccine National Fees Effective August 1, 2024 – July 31, 2025.
The 2024 /2025 flu season fees are listed below. Contractors are required to implement these fees no later than September 27, 2024. Palmetto GBA implemented the following fees on August 28, 2024, for dates of service August 1, 2024, and after. All claims processed and paid prior to August 28, 2024, will be automatically adjusted. No further action is required.
**90660 Effective 8/6/24.
Table 2. Influenza Virus Vaccine National Fees Effective August 1, 2024 – July 31, 2025.
| CPT® Codes | Description |
08/01/24 – 7/31/25 Amount |
|---|---|---|
| 90630* | Flu vacc iiv4 no preserv id | N/A |
| 90653 | Iiv adjuvant vaccine im | $83.49 |
| 90654* | Flu vacc iiv3 no preserv id | N/A |
| 90655* | Iiv3 vacc no prsv 0.25 ml im | N/A |
| 90656 | Iiv3 vacc no prsv 0.5 ml im | $22.35 |
| 90657 | Iiv3 vaccine splt 0.25 ml im | $10.93 |
| 90658 | Trivalent (IIV3), split virus, 0.5 ml | $21.86 |
| 90660** | Trivalent for Nasal | $28.87 |
| 90661 | Cciiv3 vac no prsv 0.5 ml im | $36.85 |
| 90662 | Iiv no prsv increased ag im | $83.49 |
| 90672* | Laiv4 vaccine intranasal | N/A |
| 90673 | Riv3 vaccine no preserv im | $83.49 |
| 90674* | Cciiv4 vac no prsv 0.5 ml im | N/A |
| 90682* | Riv4 vacc recombinant dna im | N/A |
| 90685* | Iiv4 vacc no prsv 0.25 ml im | N/A |
| 90686* | Iiv4 vacc no prsv 0.5 ml im | N/A |
| 90687* | Iiv4 vaccine splt 0.25 ml im | N/A |
| 90688* | Iiv4 vaccine splt 0.5 ml im | N/A |
| 90689* | Vacc iiv4 no prsrv 0.25 ml im | N/A |
| 90694* | Quadrivalent (aIIV4) inactivated, adjuvanted, pres free, 0.5 ml | N/A |
| 90756* | Cciiv4 vacc abx free im | N/A |
| Q2035* | Afluria vacc, 3 yrs & >, im | N/A |
| Q2036* | Flulaval vacc, 3 yrs & >, im | Pending: Please see IMPORTANT Footnote Below |
| Q2037* | Fluvirin vacc, 3 yrs & >, im | Pending: Please see IMPORTANT Footnote Below |
| Q2038* | Fluzone vacc, 3 yrs & >, im | Pending: Please see IMPORTANT Footnote Below |
| Q2039 | Influenza virus vaccine, nos | Specify Drug Name; May Require Invoice |
COVID-19 Administration Code and Fees:
Following are the 2024/2025 COVID-19 administration fees effective January 1, 2024.
Table 3. COVID-19 Administration Code and Fees.
|
CPT® Codes |
Description |
N.C. FSY 2025 Amount |
S.C. FSY 2025 Amount |
Va. FSY 2025 Amount |
W.Va. FSY 2025 Amount |
|---|---|---|---|---|---|
|
90480 |
Immunization administration by intramuscular inj. Coronavirus |
$42.79 |
$42.84 |
$44.23 |
$42.75 |
* Important: Please verify coding where there is no fee. This is usually an indication that there are no sources available to establish a fee. If billing a code with fee pending, you will need to provide a valid NDC for the current 2024/2025 flu season. Your claim will be rejected if incorrectly coded. The following HCPCS code to NDC crosswalk is made available for your reference. Note that some sources listed in this cross-walk represent 2019/2020. 2021/2022, 2022/2023 and 2023/2024 flu season vaccines. These resources could be rejected if provided during the current 2024/2025 flu season. This information is also located on the CMS website.
Excerpt from CMS file: October 2024 AWP NDC-HCPCS Crosswalk_00000.xlsx
Table 4. Excerpt from October 2024 CMS File.
| HCPCS Code | Short Descriptor | Labler Name | NDC | Drug Name |
|---|---|---|---|---|
|
90653 |
Liv adjuvant vaccine im |
Seqirus Inc. |
70461-0024-03 |
Fluad Trivalent (2024/2025) Preservative Free |
|
90656 |
IIV3 VACC NO PRSV 0.5 ML IM |
Seqirus Inc. |
33332-0024-03 |
Afluria Trivalent (2024/2025) Preservative Free |
|
90657 |
IIV3 VACCINE SPLT 0.25 ML IM |
Seqirus Inc. |
33332-0124-10 |
Afluria Trivalent (2024/2025) |
|
90657 |
IIV3 VACCINE SPLT 0.25 ML IM |
Sanofi Pasteur |
49281-0641-15 |
Fluzone Trivalent (2024/2025) |
|
90658 |
IIV3 VACCINE SPLT 0.5 ML IM |
Seqirus Inc. |
33332-0124-10 |
Afluria Trivalent (2024/2025) |
|
90662 |
Iiv no prsv increased ag im |
Sanofi Pasteur |
49281-0124-65 |
Fluzone High-Dose (2024/2025) Preservative Free |
|
90662 |
Liv no prsv increased ag im |
Sanofi Pasteur |
49281-0123-65 |
Fluzone High-Dose Quadrivalent (2023/2024) (Preservative Free) |
|
90670 |
PCV13 Vaccine IM |
Wyeth/Pfizer U.S. |
00005-1971-02 |
Prevnar - 13 |
|
90670 |
PCV13 Vaccine IM |
Wyeth/Pfizer U.S. |
00005-1971-05 |
Prevnar - 13 |
|
90671 |
PCV15 VACCINE IM |
Merck |
00006-4329-02 |
Vaxneuvance |
|
90671 |
PCV15 VACCINE IM |
Merck |
00006-4329-03 |
Vaxneuvance |
|
90672 |
Laiv4 vaccine intranasal |
MedImmune, LLC |
66019-0310-10 |
FluMist Quadrivalent (2023/2024) |
|
90674 |
CCIIV4 VAC NO PRSV 0.5 ML IM |
Seqirus Inc. |
70461-0323-03 |
Flucelvax Quadrivalent (2023/2024) (Preservative Free) |
|
90677 |
PCV20 VACCINE IM |
Pfizer |
00005-2000-02 |
Prevnar 20 |
|
90677 |
PCV20 VACCINE IM |
Pfizer |
00005-2000-10 |
Prevnar 20 |
|
90682 |
RIV4 VACC RECOMBINANT DNA IM |
Sanofi Pasteur |
49281-0723-10 |
Flublok Quadrivalent (2023/2024) (Preservative free) |
|
90684 |
PCV21 VACCINE IM |
Merck |
00006-4347-01 |
Capvaxive |
|
90684 |
PCV21 VACCINE IM |
Merck |
00006-4347-02 |
Capvaxive |
|
90685 |
IIV4 VACC NO PRSV 0.25 ML IM |
Seqirus Inc. |
33332-0323-03 |
Afluria Quadrivalent 0.25ml (2023/2024) (Pres Free) |
|
90686 |
IIV4 VACC NO PRSV 0.5 ML IM |
GlaxoSmithKline |
58160-0909-52 |
Fluarix Quadrivalent (2023/2024) (Pres free) |
|
90686 |
IIV4 VACC NO PRSV 0.5 ML IM |
GlaxoSmithKline |
19515-0814-52 |
Fluarix Quadrivalent (2023/2024) (Pres free) |
|
90686 |
IIV4 VACC NO PRSV 0.5 ML IM |
Sanofi Pasteur |
49281-0423-50 |
Fluzone Quadrivalent (2023/2024) (Pres Free) |
|
90686 |
IIV4 VACC NO PRSV 0.5 ML IM |
Seqirus Inc. |
33332-0323-03 |
Afluria Quadrivalent (2023/2024) (Pres Free) |
|
90687 |
IIV4 VACCINE SPLT 0.25 ML IM |
Sanofi Pasteur |
49281-0639-15 |
Fluzone Quadrivalent 0.25 mL (2023/2024) |
|
90687 |
IIV4 VACCINE SPLT 0.25 ML IM |
Seqirus Inc. |
33332-0423-10 |
Afluria Quadrivalent 0.25ml (2023/2024) |
|
90688 |
IIV4 VACCINE SPLT 0.5 ML IM |
Sanofi Pasteur |
49281-0639-15 |
Fluzone Quadrivalent (2023/2024) |
|
90688 |
IIV4 VACCINE SPLT 0.5 ML IM |
Seqirus Inc. |
33332-0423-10 |
Afluria Quadrivalent (2023/2024) |
|
90694 |
VACC AIIV4 NO PRSRV 0.5ML IM |
Seqirus Inc. |
70461-0123-03 |
Fluad Quadrivalent (2023/2024)(Pres Free) |
|
90732 |
PPSV23 VACC 2 YRS+ SUBQ/IM |
Merck |
00006-4739-00 |
Pneumovax 23 |
|
90732 |
PPSV23 VACC 2 YRS+ SUBQ/IM |
Merck |
00006-4837-02 |
Pneumovax 23 |
|
90732 |
PPSV23 VACC 2 YRS+ SUBQ/IM |
Merck |
00006-4837-03 |
Pneumovax 23 |
|
90732 |
PPSV23 VACC 2 YRS+ SUBQ/IM |
Merck |
00006-4943-00 |
Pneumovax 23 |
|
90732 |
PPSV23 VACC 2 YRS+ SUBQ/IM |
A-S Medication Solutions LLC |
50090-7036-00 |
Pneumovax 23 |
|
90739 |
HEPB VACC 2 DOSE ADULT IM |
Dynavax Technologies Co. |
43528-0002-05 |
Heplisav-B |
|
90739 |
HEPB VACC 2 DOSE ADULT IM |
Dynavax Technologies Co. |
43528-0003-05 |
Heplisav-B |
|
90740 |
HEPB VACC 3 DOSE IMMUNSUP IM |
Merck |
00006-4992-00 |
Recombivax Hb |
|
90740 |
HEPB VACC 3 DOSE IMMUNSUP IM |
A-S Medication Solutions LLC |
50090-1223-00 |
Engerix-B |
|
90740 |
HEPB VACC 3 DOSE IMMUNSUP IM |
A-S Medication Solutions LLC |
50090-1223-01 |
Engerix-B |
|
90740 |
HEPB VACC 3 DOSE IMMUNSUP IM |
GlaxoSmithKline |
58160-0821-11 |
Engerix-B |
|
90740 |
HEPB VACC 3 DOSE IMMUNSUP IM |
GlaxoSmithKline |
58160-0821-34 |
Engerix-B |
|
90740 |
HEPB VACC 3 DOSE IMMUNSUP IM |
GlaxoSmithKline |
58160-0821-43 |
Engerix-B |
|
90740 |
HEPB VACC 3 DOSE IMMUNSUP IM |
GlaxoSmithKline |
58160-0821-52 |
Engerix-B |
|
90743 |
HEPB VACC 2 DOSE ADOLESC IM |
Merck |
00006-4094-02 |
Recombivax Hb |
|
90743 |
HEPB VACC 2 DOSE ADOLESC IM |
Merck |
00006-4995-00 |
Recombivax Hb |
|
90743 |
HEPB VACC 2 DOSE ADOLESC IM |
Merck |
00006-4995-41 |
Recombivax Hb |
|
90744 |
HEPB VACC 3 DOSE PED/ADOL IM |
Merck |
00006-4094-09 |
Recombivax Hb |
|
90744 |
HEPB VACC 3 DOSE PED/ADOL IM |
Merck |
00006-4981-00 |
Recombivax Hb |
|
90744 |
HEPB VACC 3 DOSE PED/ADOL IM |
Merck |
00006-4995-41 |
Recombivax Hb |
|
90744 |
HEPB VACC 3 DOSE PED/ADOL IM |
A-S Medication Solutions LLC |
50090-1706-00 |
Engerix-B Pediatric |
|
90744 |
HEPB VACC 3 DOSE PED/ADOL IM |
GlaxoSmithKline |
58160-0820-11 |
Engerix-B Pediatric |
|
90744 |
HEPB VACC 3 DOSE PED/ADOL IM |
GlaxoSmithKline |
58160-0820-52 |
Engerix-B Pediatric |
|
90746 |
HEPB VACCINE 3 DOSE ADULT IM |
Merck |
00006-4094-02 |
Recombivax Hb |
|
90746 |
HEPB VACCINE 3 DOSE ADULT IM |
Merck |
00006-4094-09 |
Recombivax Hb |
|
90746 |
HEPB VACCINE 3 DOSE ADULT IM |
Merck |
00006-4995-00 |
Recombivax Hb |
|
90746 |
HEPB VACCINE 3 DOSE ADULT IM |
Merck |
00006-4995-41 |
Recombivax Hb |
|
90746 |
HEPB VACCINE 3 DOSE ADULT IM |
A-S Medication Solutions LLC |
50090-1223-00 |
Engerix-B |
|
90746 |
HEPB VACCINE 3 DOSE ADULT IM |
A-S Medication Solutions LLC |
50090-1223-01 |
Engerix-B |
|
90746 |
HEPB VACCINE 3 DOSE ADULT IM |
GlaxoSmithKline |
58160-0821-11 |
Engerix-B |
|
90746 |
HEPB VACCINE 3 DOSE ADULT IM |
GlaxoSmithKline |
58160-0821-34 |
Engerix-B |
|
90746 |
HEPB VACCINE 3 DOSE ADULT IM |
GlaxoSmithKline |
58160-0821-43 |
Engerix-B |
|
90746 |
HEPB VACCINE 3 DOSE ADULT IM |
GlaxoSmithKline |
58160-0821-43 |
Engerix-B |
|
90747 |
HEPB VACC 4 DOSE IMMUNSUP IM |
Merck |
00006-4992-00 |
Recombivax Hb |
|
90747 |
HEPB VACC 4 DOSE IMMUNSUP IM |
A-S Medication Solutions LLC |
50090-1223-00 |
Engerix-B |
|
90747 |
HEPB VACC 4 DOSE IMMUNSUP IM |
A-S Medication Solutions LLC |
50090-1223-01 |
Engerix-B |
|
90747 |
HEPB VACC 4 DOSE IMMUNSUP IM |
GlaxoSmithKline |
58160-0821-11 |
Engerix-B |
|
90747 |
HEPB VACC 4 DOSE IMMUNSUP IM |
GlaxoSmithKline |
58160-0821-34 |
Engerix-B |
|
90747 |
HEPB VACC 4 DOSE IMMUNSUP IM |
GlaxoSmithKline |
58160-0821-43 |
Engerix-B |
|
90747 |
HEPB VACC 4 DOSE IMMUNSUP IM |
GlaxoSmithKline |
58160-0821-52 |
Engerix-B |
|
90756 |
CCIIV4 VACC ABX FREE IM |
Seqirus Inc. |
70461-0423-10 |
Flucelvax Quadrivalent (2023/2024) |
|
90759 |
HEPB VAC 3AG 10 MCG 3 DOS IM |
VBI Vaccines |
75052-0001-10 |
PreHevbrio |
|
91304 |
SARSCOV2 VAC 5 MCG/0.5ML IM |
Novavax |
80631-0105-02 |
Novavax COVID-19 Vaccine (2023/2024) |
|
91318 |
SARSCOV2 VAC 3 MCG TRS-SUC IM |
Pfizer |
59267-4315-02 |
COVID-19 Vaccine 2023/2024 |
|
91319 |
SARSCV2 VAC 10 MCG TRS-SUC IM |
Pfizer |
59267-4331-02 |
COVID-19 Vaccine 2023/2024 |
|
91320 |
SARSCV2 VAC 30 MCG TRS-SUC IM |
Pfizer |
00069-2362-10 |
COMIRNATY 2023/2024 |
|
91320 |
SARSCV2 VAC 30 MCG TRS-SUC IM |
Pfizer |
00069-2392-10 |
COMIRNATY 2023/2024 |
|
91320 |
SARSCV2 VAC 30 MCG TRS-SUC IM |
Pfizer |
00069-2377-10 |
COMIRNATY 2023/2024 |
|
91321 |
SARSCOV2 VAC 25 MCG/.25 ML IM |
Moderna |
80777-0287-92 |
COVID-19 Vaccine 2023/2024 |
|
91322 |
SARSCOV2 VAC 50 MCG/0.5 ML IM |
Moderna |
80777-0102-96 |
Spikevax 2023/2024 |
|
91322 |
SARSCOV2 VAC 50 MCG/0.5 ML IM |
Moderna |
80777-0102-93 |
Spikevax 2023/2024 |
Disclaimer: The above list may not be all-inclusive. Please be sure you are providing vaccines appropriate for the current 2024/2025 flu season.
Pneumococcal Vaccine National Fees
The fees provided below are subject to change with each quarterly drug update. For current fees, please check the CMS website.
Table 5. Pneumococcal Vaccine National Fees.
| CPT® Codes |
Description | 1/01/25 | 04/01/25 | 07/01/25 | 10/01/25 |
|---|---|---|---|---|---|
| 90670 | Pneumococcal vacc, 13 val im | $257.99 |
|
|
|
| 90671 | Pneumococcal Conj vacc, 15 val | $253.56 |
|
|
|
| 90677 | Pneumococcal Conj vacc, 20 val | $298.04 |
|
|
|
| 90732 | Pneumococcal vaccine | $133.47 |
|
|
|
Reference Rocuments
- CR 13802 (PDF) January 2025 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files
- CR 13718 (PDF) Influenza Vaccine Payment Allowances — Annual Update for 2024/2025 Season
- CR 12439 (PDF) Claims Processing Instructions for the New Pneumococcal 15-valent Conjugate Vaccine Code 90671 and Pneumococcal 20- valent Conjugate Vaccine Code 90677
- Seasonal Influenza Vaccines Pricing