2025 HCPCS code Q2038

Influenza virus vaccine, split virus, intramuscular administration for individuals 3 years and older (Fluzone).

Refer to the CMS HCPCS coding guidelines and payer-specific guidelines for complete and accurate billing.

Modifiers may apply depending on the circumstances of administration.Consult the appropriate modifier guidelines.

Annual influenza vaccination is generally considered medically necessary for individuals 3 years of age and older to prevent influenza infection, particularly those at high-risk for complications (e.g., elderly, immunocompromised individuals).

Administration of the vaccine by a qualified healthcare professional (e.g., physician, nurse, physician assistant).

IMPORTANT Similar codes exist for other split-virus influenza vaccines (e.g., Q2034, Q2035, Q2036, Q2037, Q2039).CPT code 90658 was previously used but has been replaced by these HCPCS codes for Medicare.

In simple words: This code is for a flu shot (Fluzone) given as a muscle injection to people age 3 and older.It helps prevent the flu, but you need a new shot each year.

HCPCS code Q2038 represents the administration of a split-virus influenza vaccine, specifically Fluzone, via intramuscular injection. This vaccine is indicated for individuals aged 3 years and older.The split-virus formulation generally results in fewer adverse reactions compared to whole-virus vaccines. The vaccine is intended to prevent influenza infection caused by influenza A and B viruses.Annual revaccination is usually necessary due to the evolving strains of influenza virus.This code does not cover the treatment of existing influenza infections.

Example 1: A 65-year-old patient presents for their annual influenza vaccination. The physician administers the Fluzone vaccine (intramuscularly) and bills using HCPCS code Q2038., A pediatrician administers the Fluzone vaccine to a 4-year-old during a routine well-child visit. Code Q2038 is used for billing purposes., A public health clinic administers the Fluzone vaccine during a community flu vaccination drive.Q2038 is used to bill the insurer or public health program.

Patient demographics, date of administration, vaccine lot number, vaccine manufacturer, route of administration (intramuscular), site of administration, and documentation of the patient’s age (≥3 years).

** Always refer to the most current HCPCS codebook, CMS guidelines, and payer-specific instructions for the most accurate coding and reimbursement information.This information is current as of December 3, 2024.

  • Revenue Code: 0450 (Immunizations)
  • RVU: This would vary based on local payer contracts and may be subject to the specific geographic location of the provider. RVUs are not directly tied to the HCPCS code itself. Consult payer specific fee schedules and relevant Medicare guidelines.
  • Global Days : Not applicable; this is an immunization, not a surgical procedure.
  • Payment Status: Active
  • Modifier TC rule: Not applicable. This is a complete code.
  • Fee Schedule : Prior to January 1, 2011, CPT code 90658 was used.Specific historical fee schedules are unavailable without a more specific date and location.
  • Specialties:Family Medicine, Internal Medicine, Pediatrics, Geriatrics, Occupational Medicine
  • Place of Service:Office, Clinic, Hospital (inpatient or outpatient), Public Health Clinic, other relevant settings
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