Q2038 — Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (fluzone)
Q2038 is a HCPCS Level II code for influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (fluzone). It belongs to the Temporary Codes section. Whether Medicare pays it depends on the coverage rule below.
Medicare coverage: Special coverage instructions apply
There are published conditions attached to this code. Check the applicable coverage policy before billing it: the code being valid is not the same as the service being covered.
From the coverage field of the CMS Alpha-Numeric HCPCS File, release 2026Q3-Jul. This states Medicare’s position on the code, not on your particular claim.
Physician fee schedule statusX
Statutory exclusion. The item or service is not within the statutory definition of 'physician services', so the fee schedule never pays it.
Global period: XXX
Want the dollar amount for your locality? The fee calculator applies your GPCI and the current conversion factor.
Medically Unlikely Edits — units per day
The most units of Q2038 Medicare will pay on one date of service. Bill more on a single line and it is denied. The limit is not the same in every setting, so the row that matters is the one matching the claim you are building.
- practitioner
- 1 unit MAI 2 — Date of Service Edit: Policy · Code Descriptor / CPT Instruction
- outpatient
- 1 unit MAI 2 — Date of Service Edit: Policy · Code Descriptor / CPT Instruction
The adjudication indicator decides whether exceeding the limit is worth appealing at all: MAI 1 is a line edit you can support with documentation, MAI 3 is a date-of-service edit that is also appealable, and MAI 2 is absolute — no documentation overrides it. CMS MUE 2026Q3.
The CMS record for Q2038
- Long descriptor
- Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (fluzone)
- Short descriptor
- Fluzone vacc, 3 yrs & >, im
- Added
- January 1, 2011
- BETOS
- O1G
- Pricing indicator
- 54 — Other
The official wording. This is what the code means.
CMS's 28-character form, which is what shows up on a remittance advice.
When CMS introduced the code.
Berenson-Eggers Type of Service — CMS's own analytic grouping.
Vaccinations.
Codes adjacent to Q2038
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If Q2038 is not quite right, the correct code is very often within a few positions of it.
- Q2009Injection, fosphenytoin, 50 mg phenytoin equivalent
- Q2017Injection, teniposide, 50 mgterminated
- Q2026Injection, radiesse, 0.1 ml
- Q2028Injection, sculptra, 0.5 mg
- Q2034Influenza virus vaccine, split virus, for intramuscular use (agriflu)
- Q2035Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (afluria)
- Q2036Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (flulaval)
- Q2037Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (fluvirin)
- Q2039Influenza virus vaccine, not otherwise specified
- Q2040Tisagenlecleucel, up to 250 million car-positive viable t cells, including leukapheresis and dose preparation procedures, per infusionterminated
- Q2041Axicabtagene ciloleucel, up to 200 million autologous anti-cd19 car positive viable t cells, including leukapheresis and dose preparation procedures, per therapeutic dose
- Q2042Tisagenlecleucel, up to 600 million car-positive viable t cells, including leukapheresis and dose preparation procedures, per therapeutic dose
- Q2043Sipuleucel-t, minimum of 50 million autologous cd54+ cells activated with pap-gm-csf, including leukapheresis and all other preparatory procedures, per infusion
- Q2049Injection, doxorubicin hydrochloride, liposomal, imported lipodox, 10 mg
- Q2050Injection, doxorubicin hydrochloride, liposomal, not otherwise specified, 10 mg
- Q2052Services, supplies and accessories used in the home for the administration of intravenous immune globulin (ivig)
Questions about Q2038
What is HCPCS code Q2038?
Q2038 is a HCPCS Level II code for influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (fluzone). It sits in the Temporary Codes section.
Does Medicare cover Q2038?
The CMS HCPCS file marks Q2038 as "Special coverage instructions apply". There are published conditions attached to this code. Check the applicable coverage policy before billing it: the code being valid is not the same as the service being covered.
How is Q2038 paid under the physician fee schedule?
Q2038 carries PFS status code X. Statutory exclusion. The item or service is not within the statutory definition of 'physician services', so the fee schedule never pays it.