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Prepping for the 2018-2019 Flu Season

Posted September 24, 2018

The Centers for Disease Control and Prevention (CDC) recommends a flu shot for all patients ages six months and older without contraindications during the 2018-2019 influenza season with no preference expressed for any one vaccine over another.1 The prefilled intranasal sprayer flu vaccine, which was not recommended the past two flu seasons, is now one of several available influenza vaccines recommended by the CDC for this season.2 Please remember, it’s vital to review the Table of Approved Vaccines for 2018-2019 on the CDC website for the most recent updates on newly available products and the approved age ranges.

For 2018-2019, there is a new flu vaccine and billing code. The vaccine is preservative-free Fluad Quadrivalent Pediatric® with adjuvant MF59, for children six to 23 months of age. The Current Procedural Terminology (CPT®) code is 90689 for claims processed with dates of service (DOS) on or after Jan. 1, 2019. Before Jan. 1, 2019, claims may be submitted with 90749-Unlisted vaccine/toxoid or Q2039-Influenza virus vaccine, not otherwise specified.

Filing your claims with the accurate codes will help expedite the process. The coding chart from the American Academy of Pediatrics (AAP) gives billing codes to use based on the vaccine administered (this chart is not a comprehensive list). When billing flu vaccines, note that code descriptions are specific to vaccine products such as dosage, formulations such as trivalent vs. quadrivalent, preservative vs. preservative free, or other distinctive features (i.e. split virus, recombinant DNA, cell cultures or adjuvanted).

Review the Preventive Services Policy for Blue Cross and Blue Shield of Illinois’ (BCBSIL) complete, approved immunization schedule. It can also be found on the Clinical Payment and Coding Policies page.

As a reminder, while many BCBSIL members’ health benefit plans include influenza vaccination coverage with no member cost sharing when using a participating provider, there are some exceptions. It is important to check eligibility and benefits information to confirm details regarding copays, coinsurance and deductibles before administering the influenza vaccine to BCBSIL members.

 

1CDC, Prevent Seasonal Flu, Aug. 23, 2018, https://www.cdc.gov/flu/prevent/index.html

2CDC, Frequently Asked Flu Questions 2018-2019 Influenza Season, Aug. 30, 2018, https://www.cdc.gov/flu/about/season/flu-season-2018-2019.htm

CPT copyright 2017 American Medical Association (AMA). All rights reserved. CPT is a registered trademark of the AMA.

Third party brand names are the property of their respective owners.

This material is for informational purposes only and is not intended to be a definitive source for what codes should be used for any particular health care claim. Providers are instructed to submit claims using the most appropriate code based upon medical record documentation, coding guidelines and reference materials.

The information mentioned here is for informational purposes only and is not a substitute for the independent medical judgment of a physician. Physicians are to exercise their own medical judgment. Pharmacy benefits and limits are subject to the terms set forth in the member’s certificate of coverage which may vary from the limits set forth above. The listing of any particular drug or classification of drugs is not a guarantee of benefits. Members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions. Regardless of benefits, the final decision about any medication is between the member and their health care provider.