Key facts for Q2037
- Medicare payment
- no PFS amount
- PFS status X
- Coverage code
- D
- special coverage instructions apply
- Practitioner MUE
- 1
- MAI 2
- OPPS status
- SI L
- Influenza Vaccine; Pneumococcal Pneumonia Vaccine; Hepatitis B Vaccines; Covid-19 Vaccine; Monoclonal Antibody Therapy Product
- NCCI PTP pairs
- 28
- 28 hospital outpatient
- LCDs and articles
- 0 / 1
TL;DR
Q2037 is a Level II code from the Q section (temporary codes), in use since 2011: "Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (fluvirin)". The physician fee schedule lists Q2037 with status X (statutory exclusion: not a physician service under the fee schedule), so the PFS carries no national amount for it. CMS caps Q2037 at practitioner 1 (MAI 2, Code Descriptor / CPT Instruction); hospital outpatient 1 (MAI 2, Code Descriptor / CPT Instruction) units per day in the 2026 Q4 MUE tables. In the NCCI PTP files v323r0 Q2037 appears in 7 practitioner pairs as column 2 and 21 as column 1 (most often with 90653, 90672, 90674), and in 7 hospital outpatient pairs as column 2 and 21 as column 1. 1 billing and coding article lists Q2037 across 4 states: A54767. OPPS status indicator L: Influenza Vaccine; Pneumococcal Pneumonia Vaccine; Hepatitis B Vaccines; Covid-19 Vaccine; Monoclonal Antibody Therapy Product. HCPCS record: BETOS O1G (immunizations/vaccinations); pricing indicator 54; type of service V (pneumococcal/flu vaccine). 5 other active codes open with "Influenza virus vaccine"; related codes: Q2035, Q2036, Q2038, Q2039.
Q2037 descriptor and code status
The October 2026 HCPCS Level II file describes Q2037 as “Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (fluvirin)”. It sits in the Q section (temporary codes), listed with the other Q codes for services and supplies (non-drug). Although searches often call it the "Q2037 CPT code", Q2037 is a HCPCS Level II code maintained by CMS, not an AMA CPT code; both go in the same procedure-code field on the claim.
| Field | Value |
|---|---|
| Short descriptor | Fluvirin vacc, 3 yrs & >, im |
| Added to HCPCS | 2011-01-01 |
| Last action | N (no maintenance), effective 2014-01-01 |
| Coverage code | D: special coverage instructions apply |
| Pricing indicator | 54: vaccinations |
| BETOS category | O1G: immunizations/vaccinations |
| Type of service | V: pneumococcal/flu vaccine |
Medicare payment for Q2037
The physician fee schedule lists Q2037 with status X (statutory exclusion: not a physician service under the fee schedule), so the PFS carries no national amount for it. The amounts below are national figures from the October 2026 CMS files; the contractor applies the locality, rural or state adjustment and the beneficiary's cost sharing.
Physician fee schedule (RVU26D)
Status X: statutory exclusion: not a physician service under the fee schedule. Global period XXX (global surgery concept does not apply); PC/TC indicator 9 (professional/technical concept does not apply).
Hospital outpatient (OPPS Addendum B)
Status indicator L (Influenza Vaccine; Pneumococcal Pneumonia Vaccine; Hepatitis B Vaccines; Covid-19 Vaccine; Monoclonal Antibody Therapy Product), with no separate OPPS payment rate.
Ambulatory surgical center (Addendum BB)
Payment indicator L1 (Influenza vaccine; pneumococcal vaccine. Packaged item/service; no separate payment made).
Medically Unlikely Edits for Q2037
CMS caps Q2037 at practitioner 1 (MAI 2, Code Descriptor / CPT Instruction); hospital outpatient 1 (MAI 2, Code Descriptor / CPT Instruction) units per day in the 2026 Q4 MUE tables. The practitioner MUE is a date-of-service policy edit: units above the limit deny even when split across lines, and appeals rarely succeed.
| Setting | MUE (units/DOS) | MAI | CMS rationale |
|---|---|---|---|
| Practitioner services | 1 | 2 Date of Service Edit: Policy | Code Descriptor / CPT Instruction |
| Facility outpatient hospital | 1 | 2 Date of Service Edit: Policy | Code Descriptor / CPT Instruction |
The MUE lookup for Q2037 shows every setting next to any other code on the same claim.
NCCI edits and add-on rules
In the practitioner PTP file v323r0, Q2037 is the column-2 (bundled) code in 7 active pairs, 0% of which allow a modifier and the column-1 code in 21 (19% modifier-allowed); 2 earlier pairs have been deleted. CMS's most frequent rationale for the bundled pairs: Mutually exclusive procedures.
| Column-1 code | Pairs |
|---|---|
| 90653 (CPT; descriptor licensed by AMA) | 1 |
| 90672 (CPT; descriptor licensed by AMA) | 1 |
| 90674 (CPT; descriptor licensed by AMA) | 1 |
| 90682 (CPT; descriptor licensed by AMA) | 1 |
| 90756 (CPT; descriptor licensed by AMA) | 1 |
| Q2035 Afluria vacc, 3 yrs & >, im | 1 |
| Q2036 Flulaval vacc, 3 yrs & >, im | 1 |
| Column-2 code | Pairs |
|---|---|
| 90655 (CPT; descriptor licensed by AMA) | 1 |
| 90656 (CPT; descriptor licensed by AMA) | 1 |
| 90657 (CPT; descriptor licensed by AMA) | 1 |
| 90658 (CPT; descriptor licensed by AMA) | 1 |
| 90660 (CPT; descriptor licensed by AMA) | 1 |
| 90661 (CPT; descriptor licensed by AMA) | 1 |
| 90662 (CPT; descriptor licensed by AMA) | 1 |
| 90664 (CPT; descriptor licensed by AMA) | 1 |
In the hospital outpatient PTP file v323r0, Q2037 is the column-2 (bundled) code in 7 active pairs, 0% of which allow a modifier and the column-1 code in 21 (19% modifier-allowed); 2 earlier pairs have been deleted. CMS's most frequent rationale for the bundled pairs: Mutually exclusive procedures.
| Column-1 code | Pairs |
|---|---|
| 90653 (CPT; descriptor licensed by AMA) | 1 |
| 90672 (CPT; descriptor licensed by AMA) | 1 |
| 90674 (CPT; descriptor licensed by AMA) | 1 |
| 90682 (CPT; descriptor licensed by AMA) | 1 |
| 90756 (CPT; descriptor licensed by AMA) | 1 |
| Q2035 Afluria vacc, 3 yrs & >, im | 1 |
| Q2036 Flulaval vacc, 3 yrs & >, im | 1 |
| Column-2 code | Pairs |
|---|---|
| 90655 (CPT; descriptor licensed by AMA) | 1 |
| 90656 (CPT; descriptor licensed by AMA) | 1 |
| 90657 (CPT; descriptor licensed by AMA) | 1 |
| 90658 (CPT; descriptor licensed by AMA) | 1 |
| 90660 (CPT; descriptor licensed by AMA) | 1 |
| 90661 (CPT; descriptor licensed by AMA) | 1 |
| 90662 (CPT; descriptor licensed by AMA) | 1 |
| 90664 (CPT; descriptor licensed by AMA) | 1 |
Q2037 is neither an add-on code nor a designated primary code in the 2026 Q4 NCCI add-on edit file.
Pair counts show exposure, not the answer for one claim. Check Q2037 against a second code to see whether the pair bundles and whether a modifier can separate the services.
Medicare coverage policies for Q2037
0 active Local Coverage Determinations and 1 billing and coding article list Q2037. Each applies only in its contractor's jurisdiction, and the article carries the diagnosis codes that support the item or service.
| Article | Title | Contractor(s) | Related LCD |
|---|---|---|---|
| A54767 | Billing and Coding: Medicare Preventive Coverage for Certain Vaccines | Palmetto GBA | — |
Denials to expect on Q2037
the diagnosis or documentation does not meet the LCD or billing article that lists Q2037
the modifier reported is inconsistent with the code
the claim lacks information needed to adjudicate the line, such as an order, NPI or required modifier
Where QuickIntell fits for Q2037 claims
QuickCode supports qualified coder review of units, modifiers and NCCI pairs for Q2037 before the claim leaves, and QuickRCM carries claim readiness and the denial follow-up when an edit or coverage policy is missed.
Frequently asked questions: HCPCS Q2037
What does HCPCS code Q2037 describe?
"Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (fluvirin)" (short descriptor "Fluvirin vacc, 3 yrs & >, im"), in the Q section (temporary codes). Added 2011-01-01; last action N (no maintenance) effective 2014-01-01.
Is Q2037 a CPT code?
It is not. Q2037 belongs to the Q section (temporary codes) of HCPCS Level II, the CMS code set, not to AMA CPT. "Q2037 CPT code" searches refer to it.
What does Medicare pay for Q2037?
The physician fee schedule lists Q2037 with status X (statutory exclusion: not a physician service under the fee schedule), so the PFS carries no national amount for it.
How many units of Q2037 can be billed per day?
CMS caps Q2037 at practitioner 1 (MAI 2, Code Descriptor / CPT Instruction); hospital outpatient 1 (MAI 2, Code Descriptor / CPT Instruction) units per day in the 2026 Q4 MUE tables. For the practitioner MUE (MAI 2), units above 1 deny for the whole day as a policy limit; denials arrive as CARC 151.
Does Medicare cover Q2037?
Coverage code D (special coverage instructions apply). 1 billing and coding article lists Q2037 across 4 states: A54767.
Sources
Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-10. Verify against the primary file before billing or contracting decisions. The reference methodology explains how each figure is computed from these files.
- HCPCS Level II alpha-numeric file, October 2026Version October 2026 · effective 2026-10-01 · file HCPC2026_OCT_ANWEB_09232026.txtSHA-256 c25240c63108756d…
- Medicare PFS national relative value file RVU26D (non-QPP), October 2026Version RVU26D, released 2026-08-26 · effective 2026-10-01 · file PPRRVU2026_Oct_nonQPP.csvSHA-256 4d0d3f19bd954ffc…
- Medicare PFS national relative value file RVU26D (qualifying APM participants), October 2026Version RVU26D, released 2026-08-26 · effective 2026-10-01 · file PPRRVU2026_Oct_QPP.csvSHA-256 59d3734704853936…
- OPPS Addendum B, October 2026Version October 2026 · effective 2026-10-01 · file 508-compliant-version-2026_October_Web_Addendum_B.09.28.26.csvSHA-256 6ad7393a318bf1b9…
- Integrated Outpatient Code Editor v27.3 data tables: status and payment indicatorsVersion I/OCE v27.3 (October 2026) · effective 2026-10-01 · file Data_Status_Indicator.txtSHA-256 78f119ef0a435351…
- ASC Addendum BB (covered ancillary services), October 2026Version October 2026 · effective 2026-10-01 · file Oct 2026 ASC BB.txtSHA-256 63cdd7c72aba7a25…
- NCCI MUE table, practitioner services, effective 2026-10-01Version 2026 Q4 · effective 2026-10-01 · file MCR_MUE_PractitionerServices_Eff_10-01-2026.csvSHA-256 ef038efaf902b7bd…
- NCCI MUE table, facility services, effective 2026-10-01Version 2026 Q4 · effective 2026-10-01 · file MCR_MUE_OutpatientHospitalServices_Eff_10-01-2026.csvSHA-256 3af9f4e99cc587e2…
- NCCI MUE table, dme services, effective 2026-10-01Version 2026 Q4 · effective 2026-10-01 · file MCR_MUE_DMESupplierServices_Eff_10-01-2026.csvSHA-256 6fa4fbba852f7b74…
- NCCI PTP edits, practitioner, v323r0 (four files)Version v323r0 (2026 Q4) · effective 2026-10-01 · file ccipra-v323r0-f1.TXTSHA-256 7793c0b6686c1e22…
- NCCI PTP edits, hospital outpatient, v323r0 (four files)Version v323r0 (2026 Q4) · effective 2026-10-01 · file ccioph-v323r0-f1.txtSHA-256 063f41b91ef9faa2…
- Medicare Coverage Database, current Billing and Coding Articles exportVersion MCD release 2026-10-08 · effective 2026-10-04 · file article.csvSHA-256 5e95c4a8ac3664be…
Disclaimer
This page is an operational reference compiled from CMS publications: the HCPCS Level II file, the physician, DMEPOS and clinical laboratory fee schedules, OPPS and ASC addenda, NCCI MUE, PTP and add-on edit tables and the Medicare Coverage Database. Amounts are Medicare national figures before locality and state adjustment; Medicaid and commercial payers set their own. CPT codes are shown as numbers only; CPT descriptors are copyright AMA. Nothing here is legal, clinical or billing advice.
Found a figure that does not match the CMS file? Report a data correction with the CMS file and the value you expected; the request reaches the editorial team through the contact form.