Flu season 2014-15 is almost here. Along with updated vaccines, the October to May sneezefest brings updated coding, payment, and medical policies
from the various payers.
Here is information you need to get paid correctly for vaccines and vaccine administration this season. You can find more information about the current flu season on the TMA website. Also see what's new on the CDC website.
Aetna — For Aetna Medicare, refer to 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) — See BCBSTX's Preventive Care Service medical policy. Remember that BCBSTX pays claims submitted with National Drug Codes (NDCs) in accordance with the NDC fee schedule posted on the BCBSTX provider website under "Drugs." The fee schedule is updated on the first of each month. Read more about this NDC policy (PDF).
Cigna — See Cigna's guide to preventive health coverage (PDF). Scroll to page 6 for coding information about routine immunizations and administration of vaccines.
Humana — Read "Immunization Administration Requires Immunization Code on Claims" in Humana's YourPractice (PDF), August 2013.
Medicaid/Texas Medicaid & Healthcare Partnership—In the Texas Medicaid Provider Procedures Manual, August 2014, see section 9.2.36.2 Vaccine and Toxoid Procedure Codes
Medicare — Refer to the Centers for Medicare & Medicaid Services' (CMS') Medicare Immunization Billing (PDF) and Medicare Preventive Services (PDF) quick reference guides, and its Influenza Vaccine Payment Allowances — Annual Update for 2014-2015 Season (PDF). 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).
Are You Going to 2014 Fall Conference? Have You Had Your Flu Shot?
You can get your own flu shot, plus Tdap and MMR, at 2014 TMA Fall Conference. A variety of flu vaccination options, plus Tdap and MMR, will be available 7:45-9 am on Saturday, Sept. 13, payable on site with cash, check, or credit card. The event is sponsored by TMA's Committee on Infectious Diseases and TMA's Be Wise — Immunize.
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. 10, 2014
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