Billing Codes and Recommendations for Flu Vaccination

Date: 09/03/21

Please Note: This notice was recently updated due to guidance issued by Texas Health and Human Services.

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 season to run from October to May, and recommends vaccinations start in October and continue through March for 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. Some children, aged 6 months through 8 years, require 2 doses of flu vaccine. These children should receive their first dose as soon as possible after the vaccine becomes available, and the second dose 4 weeks later. 

Getting a flu vaccine during 2021-2022 is more important than ever due to the ongoing COVID-19 pandemic. Flu vaccination is especially important for people who are at high risk for flu, many of whom are also at high risk for COVID-19. Flu vaccines and COVID-19 vaccines can be given at the same time. 

The CDC recommends 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.

Getting the flu vaccine 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 2021-2022 seasonal flu recommendations, please visit the CDC’s Frequently Asked Influenza Questions for the 2021-2022 Season Website.

The flu vaccination is available through Superior HealthPlan medical providers or participating pharmacies. Superior Medicaid (STAR, STAR Health, STAR Kids and STAR+PLUS), CHIP and CHIP Perinate members three years of age and older have the option to obtain their vaccine at a participating pharmacy in addition to their medical provider.

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 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 additional information, please contact Provider Services at 1-877-391-5921.