Approved Flu Vaccine Billing Codes and Recommendations
Date: 09/30/19
As a reminder, the optimal time for patients to receive the influenza (flu) vaccine is as early in the season as it is available. The duration of flu season can vary, but Texas Medicaid & Healthcare Partnership (TMHP) considers the flu season to run from October to May, and recommends vaccinations start in October and continue through March to receive optimal influenza protection.
The Centers for Disease Control and Prevention (CDC) recommends that everyone 6 months of age and older, without a contraindication, receive their flu vaccination by the end of October. Providers should encourage their patients to seek their flu vaccination in a timely manner each fall.
Please note: The CDC now recommends any person with a history of an egg allergy can receive any licensed, recommended and age-appropriate flu vaccine.
Getting the flu vaccine is especially important for individuals who have a higher risk of developing serious flu-related complications that can more likely lead to hospitalization or death. High-risk individuals include, but are not limited to:
- Young children
- Pregnant women
- Immunosuppressed individuals
- Residents of nursing homes and other long-term care facilities
- People with certain chronic health conditions, such as:
- Chronic lung disease (including asthma)
- Heart disease
- Renal disease
- Metabolic disease
- Hematologic disease
- Neurologic disease
- American Indians/Alaska Natives
- People with morbid obesity (Body mass index ≥40 for adults)
- People ≥50 years of age
For more information about the 2019-2020 seasonal flu recommendations please visit the Centers for Disease Control and Prevention.
The flu vaccination is available through Superior medical providers or participating pharmacies. Superior HealthPlan Medicaid (STAR, STAR+PLUS, STAR Kids and STAR Health), CHIP and CHIP Perinate members, 7 years old and older, have the option to obtain their vaccine at a participating pharmacy in addition to their medical provider.
For Medicaid members only, in order to bill the vaccine properly under the pharmacy benefit, pharmacies must submit specific information in the subclarification code (SCC) field of ‘07’ and an ‘MA’ in the professional service code field (44Ø-E5/44Ø-EF). Only one pharmacy vaccine is permitted per season.
The vaccination is also available to all Allwell from Superior HealthPlan, Ambetter from Superior HealthPlan, and STAR+PLUS Medicare-Medicaid Plan (MMP) members, if provided by a participating pharmacy and/or medical provider licensed to administer the shot.
See below for medical billing code information:
APPROVED INFLUENZA BILLING CODES: | ||
|---|---|---|
90630 | 90660 | 90682 |
90654 | 90661 | 90685 |
90655 | 90662 | 90686 |
90656 | 90672 | 90687 |
90657 | 90673 | 90688 |
90658 | 90674 | 90756 |
APPROVED CODES FOR INFLUENZA VACCINE ADMINISTRATION: | ||
|---|---|---|
90460 | 90471 | 90473 |
90461 | 90472 | 90474 |
Please note: Hospital-based Rural Health Clinics (RHC) must submit claims for influenza vaccines as non-RHC services, under their hospital provider identifier.
For additional information, please contact Provider Services at 1-877-391-5921.