Health Information Management

Q/A: When will Medicare recognize CPT code 90661?

APCs Insider, March 15, 2013

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Q:  We have been providing Flucelvax to non-Medicare patients when prescribed by their physicians.  Is Medicare going to recognize this as a reportable drug (CPT® code 90661)?

A:  CMS acknowledges CPT codes for procedures/tests/services, but may not provide coverage or payment for them. 
 
The AMA established CPT code 90661 in 2008, but the FDA did not approve the vaccine until  November 20, 2012.
 
In Transmittal R2664CP, CMS announced that beginning April 1, 2013, it will recognize this CPT code as a covered and reimbursable service.  The status indicator will change from E to L and be effective retroactive to November 20, 2012.
 
Editor’s note: Andrea Clark, RHIA, CCS, CPCH, chairman, CEO, and founder of Health Revenue Assurance Associates, Inc., in Plantation, FL, answered this question.



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