Influenza Vaccine Fee Schedule: 22 HCPCS Codes Updated — Charge Master Action by August 17
CMS Transmittal R13859CP updates payment allowances for 22 flu vaccine HCPCS codes including Q2035–Q2039 and 90685–90688, effective August 17, 2026.
Action required by
August 17, 2026
Review the Action Required section below and ensure your team has completed all compliance steps before this date.
CMS Transmittal R13859CP establishes the annual influenza vaccine payment allowances for the 2026–2027 flu season, with an effective date of August 17, 2026. This is a Transmittal (fee schedule update) affecting the Medicare Part B payment allowances for influenza vaccines across all specialties that administer and bill flu vaccines. The single most critical compliance action: every charge master, fee schedule table, and billing system must reflect the updated allowances before the first 2026–2027 season flu vaccine claim is submitted — a missed update will result in either underpayment (if the new rate is higher) or a potential overpayment liability (if the new rate is lower).
Regulatory Background
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Quick answers
Do all 22 HCPCS codes in R13859CP apply to both professional (837P) and institutional outpatient (837I) claims, or only to one claim type?
The influenza vaccine HCPCS codes updated by R13859CP — including Q2035–Q2039 and 90653–90694 series — are used on both 837P and 837I outpatient claims depending on the billing provider type. Physician practices bill on the 837P; hospital outpatient departments and certain supplier types bill on the 837I. Both claim types are subject to the same updated Medicare payment allowances effective August 17, 2026. Confirm your specific code-to-claim-type mapping in your practice management system and update both fee schedule tables if your organization submits both claim types.
If a patient receives a flu vaccine on August 16, 2026 but the claim is not submitted until after August 17, which payment allowance applies?
Medicare payment allowances are applied based on the date of service, not the claim submission date. A vaccine administered on August 16, 2026 — one day before the R13859CP effective date — must be billed under the prior season's allowance. Claims with a date of service on or after August 17, 2026 use the new 2026–2027 allowances. Flag any claims crossing the August 17 boundary for manual date-of-service verification before submission to avoid applying the wrong rate.
Does Transmittal R13859CP add or delete any influenza vaccine HCPCS codes, or is this strictly a rate update?
Based on the transmittal action, R13859CP is a rate-only update — it revises the payment allowances for the existing 22 HCPCS codes and does not add new codes or delete existing ones. Encoder and grouper updates are not required. Only fee schedule tables, charge masters, and CDM entries need to be updated before the August 17, 2026 effective date.
Content summarized from publicly available federal publications including CMS, MAC contractors, and the Federal Register. CLV Intelligence is not affiliated with or endorsed by any government agency. This is not legal or medical advice.