Q2035 HCPCS Reimbursement & Policy

HCPCS Level II code Q2035 designates the Afluria influenza vaccine (split virus) for intramuscular administration to individuals aged 3 years and older. This vaccine code is regularly used in outpatient and community immunization settings and matters nationally due to the public health importance of seasonal influenza prevention and widespread vaccination programs. Reimbursement clarity for vaccine product codes affects provider billing workflows, patient access to immunizations, and payer-provider contracting.

Key payers in national coverage analyses include Aetna, Blue Cross Blue Shield plans, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise view of what the code represents clinically and operationally, an outline of common payer coverage patterns, and contextual information relevant to billing and claims submission for immunization services. The publication addresses benchmarks and policy considerations relevant to vaccine coding, payer coverage nuances, and typical sites of service where Q2035 is billed. Data not available in the input is noted where applicable.

Billing Code Overview

HCPCS Level II code Q2035 represents the influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Afluria). The service is a vaccine administration intended to provide seasonal influenza immunization for patients aged 3 years and older.

Service Type: Vaccine administration / immunization product
Typical Site of Service: Ambulatory clinic, physician office, mass vaccination clinic, retail pharmacy immunization area, or other outpatient settings where intramuscular vaccines are administered.

Clinical Context

A 45-year-old patient presents to a primary care clinic during influenza season requesting routine immunization. The clinician verifies immunization history, screens for contraindications and egg allergy, obtains verbal consent, documents lot number and manufacturer, and administers the intramuscular influenza vaccine Q2035 (Afluria, split virus) in the deltoid. The clinic records the date of administration, vaccine expiration, VIS edition and date, route (intramuscular), site (right or left deltoid), dose, and any observed immediate reactions. Billing staff applies the appropriate HCPCS code Q2035 with relevant modifier(s) before submitting the claim. Typical workflow includes pre-visit screening, point-of-care administration by a nurse or pharmacist, post-vaccination observation for 15 minutes for non-allergic patients, and documentation in the electronic medical record and state immunization information system.

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier (default)	Use when no special circumstances affect the service; routine administration billed as-is.
`11`

Taxonomy Code	Specialty	Notes
`207Q00000X`	Family Medicine	Primary providers who commonly administer `Q2035` in outpatient clinics.
`207R00000X`	Internal Medicine	Adult medicine clinicians routinely provide influenza vaccination.
`363L00000X`	Emergency Medicine	Emergency departments may administer influenza vaccines during visits.
`3336C0002X`	Pharmacy	Pharmacists in immunization-authorized states commonly administer `Q2035`.
`207P00000X`	Pediatrics	Providers may administer `Q2035` to patients aged 3 years and older; pediatric practices often vaccinate school-aged children.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`Z23`	Encounter for immunization	Primary diagnosis code used to indicate administration of `Q2035` influenza vaccine.
`J10.1`	Influenza due to identified seasonal influenza virus with other respiratory manifestations	Used when treating active influenza; not a vaccination diagnosis but relevant in the broader influenza care context.
`J11.1`	Influenza, virus not identified, with other respiratory manifestations	As above, relevant to clinical scenarios around influenza but not for routine vaccine administration.
`Z00.129`	Encounter for routine child health examination without abnormal findings	Used when vaccination is administered during routine pediatric preventive care visits.
`Z02.89`	Encounter for other administrative examinations	May be used when immunization occurs during administrative encounters such as school or employment physicals.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`90460`	Immunization administration through 18 years of age via any route, with counseling by physician or other qualified health care professional; first vaccine/toxoid component	Used when counseling and administration for eligible pediatric patients accompany vaccine delivery; documents counseling component when required.
`90461`	Each additional vaccine/toxoid component administered to individuals through 18 years of age	Used when multiple vaccine components are administered during the same visit for pediatric patients.
`90471`	Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular) for one vaccine (single or first component)	Commonly billed for the administration of a single intramuscular influenza vaccine in adults when separate administration coding is required by payer.
`90472`	Each additional vaccine administered (single or first component)	Billed when more than one vaccine is administered during the same encounter for adults.
`99381`	Initial comprehensive preventive medicine evaluation and management of an individual including age and gender appropriate history and counseling (new patient, 3–5 years)	May be used if vaccination occurs during a comprehensive preventive visit that meets E/M documentation and coding requirements.
`99406`	Smoking and tobacco use cessation counseling visit, intermediate, greater than 3 minutes up to 10 minutes	Example of an ancillary counseling CPT code that may be performed during the same visit; not commonly billed with routine immunization but shown as a typical concurrent service.

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Summary & Overview

HCPCS Level II Q2035: Influenza Vaccine (Afluria), IM, Ages 3+