Flu Awareness 2025 to 2026

Published 10/13/2025

Protect Your Patients: Give Them an Influenza Shot

Make a strong flu shot recommendation at every patient visit. The flu can lead to serious illness, hospitalization or even death, especially for those 65 and older or in other high-risk groups.

September and October are the best times for most people to get vaccinated. The Centers for Disease Control and Prevention (CDC) recommends annual flu shots for everyone aged six months and older.

The CDC's Recommendations of the Advisory Committee on Immunization Practices for the 2025–2026 flu season are now available.

The flu is a contagious respiratory illness caused by influenza viruses that infect the nose, throat and sometimes the lungs. It can cause mild to severe illness, and at times can lead to death.

The first and most important step in preventing the flu is by getting a flu vaccine each year. Trivalent (three-component) vaccines have been used for all flu vaccines in the United States beginning with the 20242025 season. 

The flu vaccine has been shown to reduce flu-related illnesses and the risk of serious flu complications that can result in hospitalization or death. Preventive actions like staying away from people who are sick, covering coughs and sneezes, and frequent handwashing or use of hand sanitizer, will help slow the spread of germs that cause respiratory illnesses including the flu.

Flu Symptoms

Flu symptoms usually come on suddenly. People who have the flu often feel some or all these symptoms:

  • Fever* or feeling feverish/chills
  • Cough
  • Sore throat
  • Runny or stuffy nose
  • Muscle or body aches
  • Headaches
  • Fatigue (tiredness)
  • Some people may have vomiting and diarrhea, though this is more common in children
*Not everyone with the flu will have a fever.

People at Higher Risk from the Flu

While even healthy people can get the flu, serious problems related to the flu can happen at any age. There are populations at higher risk of developing serious flu-related complications. This includes people 65 years and older, people of any age with certain chronic medical conditions (such as asthma, diabetes or heart disease), pregnant people, and children younger than 5 years.

Flu Shot: Encourage Preferred Vaccines for Patients 65 and Older

According to the CDC, people 65 years and older are at higher risk of developing serious flu complications compared with young, healthy adults. This increased risk is due in part to changes in immune defenses with increasing age. People 65 years and older bear the greatest burden of severe flu disease. It is estimated between 70 and 85 percent of seasonal flu-related deaths have occurred in people 65 years and older, and between 50 and 70 percent of seasonal flu-related hospitalizations have occurred among people in this age group.

Consider providing a preferred vaccine to your patients 65 years and older. Preferred vaccines are potentially more effective than standard-dose flu vaccines. There are three recommended vaccines:

If one of these recommended vaccines is not available, give your patients a standard-dose flu vaccine instead. Medicare Part B covers the seasonal flu shot and additional flu shots if medically necessary. Your patients pay nothing if you accept assignment.

Find out when your patients are eligible for the flu shot (PDF). We give information from claims billed in the last 18 months:

  • Current Procedural Terminology (CPT®) or Healthcare Common Procedure Coding System (HCPCS) codes
  • Dates of service
  • National Provider Identifiers (NPIs) who administered the shots

If you need help, contact your eligibility service provider.

Flu Shot & Administration 

HCPCS & CPT® Codes

Find the most current flu season’s list of billing codes, payment allowances and effective dates on the Seasonal Influenza Vaccines Pricing webpage.

Table 1. HCPCS Codes.
HCPCS Codes Descriptions
G0008 Administration of influenza virus vaccine
M0201 Administration of pneumococcal, influenza, hepatitis B, and/or COVID-19 vaccine inside a patient’s home; reported only once per individual home per date of service when such vaccine administration(s) are performed at the patient’s home.
Q2039 Influenza virus vaccine, not otherwise specified
Table 2. CPT® Codes.
CPT® Codes Descriptions
90653 Influenza vaccine, inactivated (IIV), subunit, adjuvanted, for intramuscular use
90656 Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, 0.5 mL dosage, for intramuscular use
90657 Influenza virus vaccine, trivalent (IIV3), split virus, 0.25 mL dosage, for intramuscular use
90658 Influenza virus vaccine, trivalent (IIV3), split virus, 0.5 mL dosage, for intramuscular use
90660 Influenza virus vaccine, trivalent, live (LAIV3), for intranasal use
90661 Influenza virus vaccine, trivalent (ccIIV3), derived from cell cultures, subunit, antibiotic free, 0.5 mL dosage, for intramuscular use
90662 Influenza virus vaccine (IIV), split virus, preservative free, enhanced immunogenicity via increased antigen content, for intramuscular use
90672 Influenza virus vaccine, quadrivalent, live (LAIV4), for intranasal use
90673 Influenza virus vaccine, trivalent (RIV3), derived from recombinant DNA, hemagglutinin (HA) protein only, preservative and antibiotic free, for intramuscular use
CPT® codes and modifiers begin with a numeric character and HCPCS codes and modifiers begin with an alpha character. All Current Procedural Terminology (CPT®) codes and descriptors are copyrighted 2024 by the American Medical Association.

Starting January 1, 2025, you were able to begin reporting HCPCS code G2211 and E/M services (CPT® codes 99202–99205 and 99211–99215) billed with CPT® modifier 25 only when performed on the same day as:

  • Annual wellness visit (HCPCS codes G0438 and G0439)
  • Vaccine administration
  • Any Part B preventive service provided in the office or outpatient setting, except glaucoma screenings

ICD-10 Codes: Z23
Additional ICD-10 codes may apply. Find individual change requests and specific ICD-10-CM service codes we cover on the CMS ICD-10 webpage. See Palmetto GBA's website for more information.

Medicare Coverage
Medicare Covers patients with Medicare Part B.

Frequency

  • Once per flu season
  • We cover additional flu shots if medically necessary

Patient Pays
No copayment, coinsurance or deductible.

Additional Information

  • Most Medicare providers may bill and get paid for flu shot services
  • Medicare may make an additional payment for in-home flu shot administration under certain circumstances

Resources


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