Flu Shot CPT code list
• 90655-Influenza virus vaccine, split virus, preservative free, when administered to children 6-35 months of age, for intramuscular use;
• 90656-Influenza virus vaccine, split virus, preservative free, when administered to individuals 3 years and older, for intramuscular use;
• 90657-Influenza virus vaccine, split virus, when administered to children 6-35 months of age, for intramuscular use;
• 90658-Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use; or
• 90660-Influenza virus vaccine, live, for intranasal use. Step 4 Bill one of the following administration codes for the administration of the seasonal influenza vaccine:
Billing Guidelines
CIGNA has developed the following billing guidelines for the prophylactic administration of the H1N1 vaccine. Facilities should use revenue code 771 with G9141 or revenue code 771 with 90470 when submitting claims for the H1N1 vaccine administration.
H1N1 Only When the H1N1 vaccine is administered without the seasonal influenza vaccine, complete all steps, 1 and 2:
Step 1
Bill G9141 – Influenza A (H1N1) immunization administration (includes the physician counseling the patient/family)for the administration of the H1N1 vaccine.
OR
Bill 90470 – H1N1 immunization administration (intramuscular, intranasal), including counseling when performed Use G9141 or 90470 to promote prompt payment as these codes will not be subject to copay or deductible and coinsurance. You may bill with either G9141 or 90470 to submit for H1N1 vaccine administration reimbursement as both codes will be processed in the same manner.
Step 2
Bill V04.81 – need for prophylactic vaccination and inoculation, influenza, as the appropriate ICD-9 code.
H1N1 and Seasonal Flu Vaccine When both the seasonal influenza vaccine and the H1N1 vaccine are administered to the same individual on the same date of service, complete Steps 1 – 4:
Step 1
Bill G9141 – Influenza A (H1N1) immunization administration (includes the physician counseling the patient/family) for the administration of the H1N1 vaccine. OR Bill 90470 – H1N1 immunization administration (intramuscular, intranasal), including counseling when performed Use G9141 or 90470 to promote prompt payment as these codes will not be subject to the usual copay or deductible and coinsurance. You may bill with either G9141 or 90470 to submit for H1N1 vaccine administration reimbursement as both codes will be processed in the same manner
Step 2
Bill V04.81 – need for prophylactic vaccination and inoculation, influenza, as the appropriate ICD-9 code.
Step 3
Bill one of the appropriate seasonal flu vaccine codes:
Wellcare – Flu Vaccination Season 2012-2013
This communication provides you with important information regarding the 2012-2013 flu season (September 1,2012 through April 15,2013)and Wellcare/HealthEase (The Plan’s) flu vaccination claim administration guidelines.
These guidelines do not apply for claims submitted outside of the dates of service September 1,2012 through April 15, 2013.
Vaccination recommendations for this season have not changed and still include all persons ages 6 months and older.
The Plan offers FREE flu vaccinations for its members. Please encourage our members to receive the flu vaccination at any of the following locations:
Physician Offices – Member co-payments are not required for this service
Non-Capitated Providers – If you are a Non-Capitated Provider, you will be reimbursed for administering the flu vaccine based upon your contractual agreement with the Plan, medical group and/or IPA.
Capitated Providers
a. Capitated Providers who receive the vaccine through Vaccines for Children (VFC) should bill one of the following CPT codes to receive payment for only the administration of the flu vaccine:
90655 – Influenza virus vaccine, children 6-35 ,months (preservative free)
90656 – Influenza virus vaccine, individuals 3 years and older (preservative free)
90657 – Influenza virus vaccine, children 6-35 months
90662 – Influenza virus vaccine, individuals 3 years and older
b. Capitated Providers who do NOT receive the vaccine through VFC should beill code G0008 to receive reimbursement for the administration of the flu vaccine and ALSO bill one of the following CPT codes to receive payment for the vaccine:
90655 – Influenza virus vaccine, children 6-35 ,months (preservative free)
90656 – Influenza virus vaccine, individuals 3 years and older (preservative free)
90657 – Influenza virus vaccine, children 6-35 months
90662 – Influenza virus vaccine, individuals 3 years and older
Participating Pharmacies – Members can receive a FREE flu vaccine at local participating pharmacies. For information or to find a nearby location, member should call the Customer Service number on the back of their member ID card. With a Plan ID card, members are eligible for a FREE flu vaccine with no co-payment.
Community-based Clinics – Mollen immunization clinics are held throughout the community at local retail pharmacies and/or community centers. To locate a Mollen imminization clininc, members should call 1-877-279-3588, Option 7 or log on to www.flushotsusa.com to find a clinic scheduled near their home or work address.
Members who receive their flu vaccine at a location other than a participating provider, pharmacy location or community-based clinic must submit a detailed receipt with their bill. The Plan will reimburse members up to a maximum of our in-network cost of $25.00 for the administration of the flu vaccine. Members should submit a detailed receipt with their full name, current address, date of birth, Plan ID#, date of service and amount paid; along with proof of payment (cancelled check, credit card receipt, etc.) to the following address:
Wellcare Health Plans
Attn: Reimbursement Department
P O Box 31577
Tampa, FL 33634-3577
Provider Services contact at 1-888-888-9355 (Medicare), 1-800-278-0656 (HealthEase), 1-800-278-8178 (HealthEase Kids), 1-866-334-7927 (Staywell), 1-866-698-5437(Staywell Kids) or (TTY/TDD (all plans) – 877-247-6272).
