Quick Billing Checklist – Flu Season 2025–2026 

Diagnostic Testing Codes (CLIA Waived) 

Test	CPT Code	Modifier	Sample Type
Flu Rapid	87804	QW*	Nasal/Throat
COVID-19 Rapid	87811	QW*	Nasal
Strep A Rapid	87880	QW*	Throat

* QW modifier and valid CLIA Certificate of Waiver required for Medicare and many commercial payers. Include CLIA # on claim. 

Common Flu Vaccine Codes & Allowances (Examples) 

Note: Below are examples of commonly billed codes. Multiple flu vaccine formulations exist; verify correct code selection by age, product, and payer guidance. 

Code	Description	Allowance
90658	IIV3, 0.5mL IM (Adult example)	$22.07
90657	IIV3, 0.25mL IM (Pediatric example)	$11.03
90622	High-Dose IIV3, IM (Medicare adult)	$98.16
90660	LAIV3, Intranasal	$29.71
90673	RIV3 Recombinant, IM (e.g., Flublok)	$98.16

Administration Codes 

• Medicare: G0008 (flu vaccine), M0201 (in-home administration) 

• Commercial: 90471 (first injection), 90472 (each additional injection) 

• Pediatric: 90460/90461 (≤18 yrs with counseling, per component) 

Diagnosis Code: Z23 (encounter for immunization) 

Key Billing Scenarios (Examples) 

Note: Vaccine codes below are examples; confirm the appropriate product-specific code for the vaccine administered. 

• Routine Adult Flu Shot: 90658 (Afluria Trivalent) + 90471 (Non-Medicare) or G0008 (Medicare) 

• Medicare Dual Vaccine (Flu + Pneumonia): 90662 (Fluzone High-Dose Trivalent Preservative Free) + G0008; 90732 (Pneumovax 23) + G0009 

• Same-Day E/M + Flu Shot: E/M code (e.g., 99213-25, low-level MDM) + flu vaccine code + 
  90471 (Non-Medicare) 

Top Billing Errors to Avoid 

• Missing QW modifier and/or missing CLIA Certificate of Waiver for waived tests 

• Wrong administration code (Medicare vs Commercial) 

• E/M billed without modifier -25 for same-day vaccine 

• Incorrect vaccine code for patient age (select based on formulation and guidelines) 

• Missing lot number, dosage, or VIS documentation 

Compliance Quick Check 

• Verify benefits & eligibility before administration 

• Document lot #, expiration, dose, route, and VIS date 

• Report to immunization registry if required 

• File claims within timely filing limits