The 2013-14 flu season — those sniffly months from October to May — is upon us. Along with updated vaccines, the season brings updated coding, payment, and medical policies from the various payers. Here is where you can find current information to make sure you get paid correctly for vaccines and vaccine administration. You can find more information about the current flu season on the TMA website.
Aetna — For Aetna Medicare, refer to Refer to the Centers for Medicare & Medicaid Services’ (CMS’) Medicare Preventive Services (PDF) quick reference guide. For Aetna commercial plans, go to Aetna’s secure provider portal, NaviNet. Click on Aetna Health Plan>Claims>Policy Information>Benefits Guidance Statement>Routine Preventive Care Services.
Blue Cross and Blue Shield of Texas (BCBSTX) — Go to Medical Policies webpage and search for “preventive care services.” Search also for “immunization” to view the BCBSTX Recommended Immunization Schedule for Children and Adults.
Cigna — See Cigna’s guide to preventive health coverage (PDF). Scroll to page 7 for coding information about routine immunizations and administration of vaccines.
Humana — See Humana's YourPractice (PDF), August 2013; read “Immunization Administration Requires Immunization Code on Claims.”
Medicaid/Texas Medicaid & Healthcare Partnership — In the Texas Medicaid Procedures Manual, September 2013, see section 126.96.36.199 Vaccine and Toxoid Procedure Codes
Medicare — CMS’ Medicare Immunization Billing (PDF) and Medicare Preventive Services (PDF) quick reference guides, and its Influenza Vaccine Payment Allowances — Annual Update for 2013-2014 Season. Be sure to bill codes for both the actual vaccine and for the appropriate vaccine administration code.
UnitedHealthcare (UHC) — See Coding Summary for Providers (PDF); scroll to the Immunizations section on page 3. See also UHC’s preventive care services medical policy (PDF).
Have You Had Your Flu Shot?
You can get your own flu shot and other vaccinations recommended for health care professionals at 2013 TMA Fall Conference. Physicians and their families, medical students, and office staff can get a vaccination Saturday, Oct. 19, from 7:30 to 8:30 am. The event is sponsored by TMA’s Committee on Infectious Diseases and Be Wise — Immunize .
Flu shots, including the new quadrivalent vaccine, and flu mist will be available. You also can get a Tdap (tetanus, diphtheria, and pertussis) or MMR (measles, mumps, rubella) vaccination. Costs will be: flu shots, $27; quadrivalent vaccination (limited supply), $40; FluMist, $40; Tdap shots, $80; and MMR, $105. Be sure to reserve your vaccination when you register for TMA’s Fall Conference.
Host a Flu Shot Clinic
Be Wise — Immunize has the tools you need to plan, organize, and carry out a flu shot clinic in your community. Visit the Be Wise website for details and more information about immunizations.
Be Wise — Immunize is a service mark of the Texas Medical Association.
Published Sept. 26, 2013
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