HCPCS Q2037 is officially defined as "Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (fluvirin)." HCPCS Q2037 is referenced in 3 tracked payer policy changes from Michigan Medicaid - MDHHS and Aetna. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for HCPCS Q2037 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.
Michigan Medicaid has updated CPT and HCPCS codes effective July 1, 2025, adding new covered codes for various provider types and discontinuing several existing codes. This affects billing for Medicaid, Healthy Michigan Plan, and related programs in Michigan.
Aetna considers FDA-approved influenza vaccines medically necessary when the product matches the member's age: standard or preservative-free trivalent injectables such as Afluria, Fluarix, Flucelvax and Fluzone for members 6 months of age or older, Flublok for members 9 years of age or older, Fluad and Fluzone High-Dose for members 65 years of age and older, mFLUSIVA mRNA trivalent injectable for members 50 years of age or older, and FluMist trivalent intranasal vaccine for members 2 through 49 years of age. The CDC does not recommend FluMist for individuals who are pregnant or immunocompromised, or who have certain medical conditions such as asthma. CPT 90664 (pandemic formulation live influenza vaccine) and ICD-10 codes for immune mechanism disorders, asthma and pregnancy are listed as not covered for the indications in the policy. For the 2025-2026 season, the CDC recommends an updated flu vaccine for everyone 6 months of age and older, with rare exceptions.
Aetna considers FDA-approved influenza vaccines medically necessary by age: standard or preservative-free trivalent injectables (Afluria, Fluarix, Flucelvax, Fluzone) for members 6 months of age or older, Flublok for members 9 years or older, preservative-free trivalent injectables Fluad and Fluzone High-Dose for members 65 years or older, the mRNA trivalent injectable mFLUSIVA for members 50 years or older, and the trivalent intranasal vaccine FluMist for ages 2 through 49. Aetna considers the intranasal vaccine FluMist covered under CPT 90660 when the selection criteria are met, and CPT 90664 (pandemic formulation live intranasal vaccine) is listed as not covered for the indications in the policy. Avian influenza A (H5N1) vaccines are approved by the FDA for persons at increased risk of exposure, but are not routinely available or recommended for the general U.S. population.
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