Q2036 HCPCS code: Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (flulaval)
Q2036 is the HCPCS Level II code for influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (flulaval). In 2022 Medicare paid an average of $9.74 per service for Q2036 across 13 services. Its Medicare coverage code is D (Special coverage instructions apply): Medicare covers it when its national or local coverage criteria are met. The NCCI unit limit is 1 per day on outpatient hospital claims. In 2022, about 12 clinicians billed Medicare for Q2036 for 13 beneficiaries.
Code details
| Field | Value |
|---|---|
| Section | Q codes — Temporary codes |
| Coverage code | D — Special coverage instructions apply |
| Pricing indicator | 54 |
| BETOS category | O1G — Immunizations/vaccinations |
| Added | 2011-01-01 |
| Last action effective | 2014-01-01 |
Who bills Q2036 (2022)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 12 |
| Medicare beneficiaries | 13 |
| States with claims | 0 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for Q2036, 2022–2022
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 13 | 13 | $9.74 | $9.74 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 1 | Code Descriptor / CPT Instruction |
| practitioner claims | 1 | Code Descriptor / CPT Instruction |
Medicare policy articles for this code
- A54767: Billing and Coding: Medicare Preventive Coverage for Certain Vaccines (Palmetto GBA (MAC - Part A, MAC - Part B))
Covered diagnoses (3,490 ICD-10-CM codes)
The diagnoses most often listed as covered in the policy articles above:
| ICD-10-CM | Diagnosis | Articles listing it |
|---|---|---|
| S00.01XA | Abrasion of scalp, initial encounter | 1 |
| S00.02XA | Blister (nonthermal) of scalp, initial encounter | 1 |
| S00.04XA | External constriction of part of scalp, initial encounter | 1 |
| S00.05XA | Superficial foreign body of scalp, initial encounter | 1 |
| S00.06XA | Insect bite (nonvenomous) of scalp, initial encounter | 1 |
| S00.07XA | Other superficial bite of scalp, initial encounter | 1 |
| S00.201A | Unspecified superficial injury of right eyelid and periocular area, initial encounter | 1 |
| S00.202A | Unspecified superficial injury of left eyelid and periocular area, initial encounter | 1 |
| S00.211A | Abrasion of right eyelid and periocular area, initial encounter | 1 |
| S00.212A | Abrasion of left eyelid and periocular area, initial encounter | 1 |
Showing 10 of 3,490. The full list, non-covered diagnoses and CSV export are in Caduvo.
What changed for Q2036
- 2011-01-01: Q2036 added to HCPCS Level II
- Next scheduled CMS quarterly update (HCPCS and DMEPOS fee schedule): 2027-01-01
Frequently asked questions
What is HCPCS code Q2036?
Q2036 is the HCPCS Level II code for influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (flulaval). Short descriptor: "Flulaval vacc, 3 yrs & >, im".
How much does Medicare pay for Q2036?
In 2022, the average Medicare payment was $9.74 per service (average allowed $9.74).
Does Medicare cover Q2036?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
Which diagnoses support coverage for Q2036?
Medicare policy articles that cite Q2036 list 3,490 covered ICD-10-CM diagnosis codes across 1 article. The most cited include S00.01XA (Abrasion of scalp, initial encounter), S00.02XA (Blister (nonthermal) of scalp, initial encounter), S00.04XA (External constriction of part of scalp, initial encounter). A listed diagnosis is necessary but not sufficient; the policy's other criteria still apply.
How many units of Q2036 can be billed per day?
1 on outpatient hospital claims; 1 on practitioner claims (NCCI medically unlikely edits).
Related Q20 codes
- Q2004 — Irrigation solution for treatment of bladder calculi, for example renacidin, per 500 ml
- Q2009 — Injection, fosphenytoin, 50 mg phenytoin equivalent
- Q2017 — Injection, teniposide, 50 mg
- Q2026 — Injection, radiesse, 0.1 ml
- Q2028 — Injection, sculptra, 0.5 mg
- Q2034 — Influenza virus vaccine, split virus, for intramuscular use (agriflu)
- Q2035 — Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (afluria)
- Q2037 — Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (fluvirin)
- Q2038 — Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (fluzone)
- Q2039 — Influenza virus vaccine, not otherwise specified
- Q2040 — Tisagenlecleucel, up to 250 million car-positive viable t cells, including leukapheresis and dose preparation procedures, per infusion
- Q2041 — Axicabtagene ciloleucel, up to 200 million autologous anti-cd19 car positive viable t cells, including leukapheresis and dose preparation procedures, per therapeutic dose
Building a device that would bill under a code like this? Caduvo matches a device description to HCPCS/CPT codes, Medicare coverage and payment, and the FDA pathway in one report.
Next steps
- Run a reimbursement report for a device billed under Q2036
- Watch Q2036 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for Q2036
Sources: CMS HCPCS Level II release October 2025; CMS DMEPOS fee schedule; CMS NCCI MUE tables; CMS Medicare utilization (physician and DME supplier files); CMS Medicare Coverage Database articles. Fees are Medicare allowables, not commercial rates. Not billing or legal advice.