Billing Codes and Recommendations for Flu Vaccination

Date: 10/14/22

As a reminder, Superior HealthPlan Medicaid (STAR, STAR Health, STAR Kids and STAR+PLUS) and CHIP members 3 years of age and older have the option to obtain their flu vaccine with their Superior medical provider or at a participating pharmacy. The vaccination is also available to Wellcare By Allwell (HMO and HMO DSNP), Ambetter from Superior HealthPlan and Superior HealthPlan STAR+PLUS Medicare-Medicaid Plan (MMP) members, if provided by a participating pharmacy and/or medical provider licensed to administer the shot. 

The optimal time for patients to receive the flu vaccine is as early in the season as it is available. The duration of flu season can vary, but the Centers for Disease Control and Prevention (CDC) considers the season to run from October to May. The CDC recommends:

• Flu vaccinations to start in October and continue through March for optimal influenza protection.
• Everyone 6 months of age and older, without a contraindication, receive their flu vaccination by the end of October.
  • Some children, aged 6 months through 8 years, require 2 doses of flu vaccines. These children should receive their first dose as soon as possible after the vaccine becomes available, and the second dose 4 weeks later. 
• Members who are not able to get vaccinated until November or later, should still get vaccinated.
  • The flu most commonly peaks in February and significant activity can continue into May.
• People with a history of egg allergy, of any severity, should receive any licensed, recommended and age-appropriate flu vaccine.
  • Those who have a history of severe allergic reaction to egg (i.e., any symptom other than hives) should be vaccinated in an inpatient or outpatient medical setting, under the supervision of a health-care provider who is able to recognize and manage severe allergic conditions.
  • For more information, please visit CDC's Flu Vaccine and People with Egg Allergies webpage.

Providers should encourage their patients to seek their flu vaccination in a timely manner each fall. Getting a flu vaccine during 2022-2023 is more important than ever due to the COVID-19 pandemic. It is especially important for individuals who are at a higher risk of developing serious flu-related complications that are more likely to lead to hospitalization or death. High-risk individuals include, but are not limited to:

• Children younger than 2 years of age.
• Pregnant women and women up to 2 weeks after the end of pregnancy.
• 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 (such as diabetes).
  • Hematologic disease.
  • Neurologic disease.
• American Indians/Alaska Natives.
• People with morbid obesity (body mass index ≥40 for adults).
• People 65 years of age or older.
• People who have had a stroke.

For more information about the 2022-2023 seasonal flu recommendations, please visit the CDC’s Frequently Asked Influenza Questions for the 2022-2023 Season Website.

See below for flu vaccine billing code information:

APPROVED INFLUENZA VACCINE BILLING CODES:
90662	90672	90674	90682
90685	90686	90687	90688
90694	90756

 

APPROVED INFLUENZA VACCINE ADMINISTRATION CODES:
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 any questions or additional information, please contact Provider Services at 1-877-391-5921.