G0008 — Administration of influenza virus vaccine

What the market charges

Across 1,100 negotiated rates, the middle 80% fall between $13 and $128, with a median of $56.

What Medicare pays

Medicare allowed an average of $29 for this code, across 11,327,224.5 services billed by 112,062 providers. At the median, the market charges 1.9 times what Medicare pays for this code.

Where this is billed, and what it costs there

The states billing G0008 most, by Medicare service volume, each compared against the national average of $29. Each links to the providers Mishe lists there.

• California — 8,975 providers billed it, Medicare allowed $32 — 10% above the national average
• Florida — 6,219 providers billed it, Medicare allowed $28 — 3% below the national average
• New York — 6,663 providers billed it, Medicare allowed $32 — 10% above the national average
• Texas — 7,359 providers billed it, Medicare allowed $28 — 3% below the national average
• Idaho — 382 providers billed it, Medicare allowed $33 — 14% above the national average
• Pennsylvania — 6,289 providers billed it, Medicare allowed $30 — 3% above the national average
• Illinois — 4,354 providers billed it, Medicare allowed $30 — 3% above the national average
• New Jersey — 4,084 providers billed it, Medicare allowed $32 — 10% above the national average

Claim-editing rules

These are National Correct Coding Initiative procedure-to-procedure edits — the rules a payer applies when deciding whether two codes billed together are both payable.

Codes this one absorbs

Billed together, G0008 is the payable code and these are not separately payable. 3 pairs in total.

• 36591 — no modifier can override this edit
• 36592 — no modifier can override this edit
• 96523 — no modifier can override this edit

Codes that absorb this one

Billed alongside any of these, G0008 is not separately payable. 4 pairs in total.

• 90460 — a modifier may allow both to be paid
• 90471 — a modifier may allow both to be paid
• 90473 — a modifier may allow both to be paid
• G0162 — a modifier may allow both to be paid

Other codes

• J2777 — Injection, faricimab-svoa, 0.1 mg
• J0897 — Injection, denosumab, 1 mg
• J9271 — Injection, pembrolizumab, 1 mg
• J0129 — Injection, abatacept, 10 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)
• G0439 — Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit
• J9144 — Injection, daratumumab, 10 mg and hyaluronidase-fihj
• J9299 — Injection, nivolumab, 1 mg
• J1745 — Injection, infliximab, excludes biosimilar, 10 mg
• J2357 — Injection, omalizumab, 5 mg
• A0427 — Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency)

Deploy this for your team

Every figure on this page came from published payer and Medicare data, assembled by Mishe. The same pricing, claim-editing and care-pathway intelligence runs underneath the plans Mishe operates.

• Contact Mishe to learn how to deploy these resources for your team
• Guides to direct-pay healthcare
• Cash prices by procedure
• Find a provider by state

Take back healthcare.