Products billed under this code include Afluria Trivalent (2025/2026) (Preservative Free), FluLaval Trivalent (2025/2026) Preservative Free, Fluarix Trivalent (2025/2026) Preservative Free, Fluzone Trivalent (2025/2026) (Preservative Free).
Payment limit per 0.5 ML, by effective quarter, 4Q24 to 4Q26. Gaps mean the code was not in that quarter’s file, or CMS gave no payment limit.From the 4Q26 NDC–HCPCS crosswalk. “Limit / pkg” is the 4Q26 payment limit times the billing units in one package.
| Product | Labeler | NDC | Units / pkg | Limit / pkg |
|---|---|---|---|---|
| Afluria Trivalent (2025/2026) (Preservative Free) | Seqirus Inc | 33332-0025-03 | 10 | $238.89 |
| FluLaval Trivalent (2025/2026) Preservative Free | GlaxoSmithKline | 19515-0904-52 | 10 | $238.89 |
| Fluarix Trivalent (2025/2026) Preservative Free | GlaxoSmithKline | 58160-0912-52 | 10 | $238.89 |
| Fluzone Trivalent (2025/2026) (Preservative Free) | Sanofi Pasteur | 49281-0425-50 | 10 | $238.89 |
| Quarter | Payment limit | Change | Billing unit | Description | Source file |
|---|---|---|---|---|---|
| 4Q26 | $23.889 | +$0.674 | 0.5 ML | IIV3 VACC NO PRSV 0.5 ML IM | v1, posted September 17, 2026 |
| 3Q26 | $23.215 | $0.00 | 0.5 ML | IIV3 VACC NO PRSV 0.5 ML IM | v1, posted September 15, 2026 |
| 2Q26 | $23.215 | $0.00 | 0.5 ML | IIV3 VACC NO PRSV 0.5 ML IM | v1, posted September 15, 2026 |
| 1Q26 | $23.215 | $0.00 | 0.5 ML | IIV3 VACC NO PRSV 0.5 ML IM | v1, posted September 15, 2026 |
| 4Q25 | $23.215 | +$0.865 | 0.5 ML | IIV3 VACC NO PRSV 0.5 ML IM | v1, posted September 8, 2026 |
| 3Q25 | $22.35 | $0.00 | 0.5 ML | IIV3 VACC NO PRSV 0.5 ML IM | v1, posted March 10, 2026 |
| 2Q25 | $22.35 | $0.00 | 0.5 ML | IIV3 VACC NO PRSV 0.5 ML IM | v1, posted March 10, 2026 |
| 1Q25 | $22.35 | $0.00 | 0.5 ML | IIV3 VACC NO PRSV 0.5 ML IM | v1, posted December 19, 2025 |
| 4Q24 | $22.35 | – | 0.5 ML | IIV3 VACC NO PRSV 0.5 ML IM | v1, posted June 11, 2025 |
“Change” is the difference from the previous quarter, shown only when both quarters have a payment limit and the billing unit is the same. “vs. last quarter” and “vs. a year ago” follow the same rule.
