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Influenza Vaccine

Seasonal Influenza Vaccine

90655 Influenza virus vaccine, split virus, preservative free, for children 6-35 months of age, for intramuscular or jet injection use
90656 Influenza virus vaccine, split virus, preservative free, for use in Individuals three years of age and above, for intramuscular use
90657 Influenza virus vaccine, split virus, 6-35 months dosage, for intramuscular or jet injection use
90658 Influenza virus vaccine, split virus, 3 years and above dosage, for intramuscular or jet injection use

Effective for dates of service on or after September 1, 2006: This is a standard PMD immunization. An employer group may or may not elect to cover routine immunizations. Verify benefits on each subscriber. The vaccine may be considered medically necessary for patients who do not have coverage for routine immunizations. Click here to view the medical policy for non-routine use of the influenza vaccine.

We generally follow the age and frequency recommendations as issued by the ACIP/CDC for vaccines found within the Primary Changes and Updates in the Recommendations for the Flu vaccine.

Please use the appropriate administration code when filing for the administration fee. 

H1N1 Influenza Vaccine


90470

H1N1 immunization administration (intramuscular, intranasal), including counseling when performed.

90663

Influenza virus vaccine, pandemic formulation, H1N1

Effective September 28, 2009, providers should bill CPT code 90470 for the administration of the H1N1 influenza virus vaccine.  There will be no reimbursement for the H1N1 vaccine (CPT code 90663) since it is being provided free of charge by the federal government.

The H1N1 vaccine is not intended to replace the seasonal flu vaccine.  If a group has our standard immunization coverage, the administration fee for the H1N1 vaccine will be covered.  If additional doses are administered to comply with CDC recommendations, the additional administration fee will be covered.

The CDC’s recommendations on the use of this vaccine are available on the CDC web site, www.cdc.gov, and should be followed closely.

Effective 1/21/09, we cover two units of CPT Code, 87804 when two different strains of the flu virus are tested. Medical records should clearly document the strains and results from each.

Last Updated January 2010