`Q2036` Flulaval vacc, 3 yrs & >, im

Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (flulaval)

Medicare coverage: Special coverage instructions apply
Status: active (October 2026 file)

Medically Unlikely Edits (effective October 1, 2026)

Practitioner: max 1 units per day (policy), rationale: Code Descriptor / CPT Instruction
Outpatient hospital: max 1 units per day (policy), rationale: Code Descriptor / CPT Instruction

Medicare pricing for Q2036

Physician Fee Schedule (CY 2026, RVU26D)

Status X: statutory exclusion, not paid under the PFS.

Payer policies and prior authorization for Q2036

Payer coverage policies that name Q2036

Q2036 appears in 3 coverage policies from Aetna, Blue Cross & Blue Shield of Rhode Island, BlueCross BlueShield of South Carolina.

Payer	Policy	Role in policy	Reviewed	Document
Aetna	Influenza Vaccines (0035)	covered if criteria are met	Oct 8, 2026	payer document
Blue Cross & Blue Shield of Rhode Island	Immunizations Adult and Pediatric MEDICAL COVERAGE POLICY \| 5	covered if criteria are met	Jun 9, 2026	payer document
BlueCross BlueShield of South Carolina	Preventive Services for Non-Grandfathered (PPACA) Plans: Immunizations (CAM 109)	listed, no stance	Apr 1, 2026	payer document

Medicaid fee-for-service

Prior authorization required or conditional in IN.

KS: $20.16 (default), effective Jan 1, 2011
KY: $0.00 (asc), effective Jan 1, 2026
ND: $0.00 (physician), effective Aug 1, 2026
VA: $8.57 (medical), effective Jan 1, 2015
VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026
WY: $0.00 (professional), effective Jan 1, 2017

From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.

Q2036 Flulaval vacc, 3 yrs & >, im