All Alliance members are eligible to receive the Influenza vaccine. Members who are linked to your practice or to another PCP do not need a referral to receive vaccines. The following codes are applicable to all lines of business.
| Vaccine Name | Dosage | Age Group | CPT Code |
| Afluria® (IIV4) | 0.5 mL preservative free,
split virus |
5 years & older | 90686 |
| Fluad® (IIV) | 0.5 mL adjuvanted | 65 years & older | 90653 |
| Fluarix® (IIV4) | 0.5 mL preservative free,
split virus |
6 months & older | 90686 |
| Flublock Quadrivalent® (RIV4) | 0.5 mL antibiotic/
preservative free |
18 years & older | 90682 |
| Flucelvax® (ccIIV4) | 0.5 mL antibiotic/
preservative free |
4 years & older | 90674 |
| 0.5 mL antibiotic free | 4 years & older | 90756 | |
| FluLaval® (IIV4) | 0.5 mL preservative free,
split virus |
6 months & older | 90686 |
| 0.5 mL split virus | 6 months & older | 90688 | |
| Flumist Quadrivalent® (LAIV4) | 0.2 mL live virus intranasal
spray |
2 through 49 years | 90672 |
| Fluzone® (IIV4) | 0.25 mL preservative free,
split virus |
6 through 35 months | 90685 |
| 0.5 mL preservative free,
split virus |
3 years & older | 90686 | |
| 0.5 mL split virus | 6 months & older | 90688 | |
| Fluzone® Intradermal (IIV4-ID) | 0.1 mL preservative free | 18 through 64 years | 90630 |
| Fluzone® High Dose (IIV) | 0.5 mL preservative free | 65 years & older | 90662 |
| *Effective Jan. 1, 2019, the Alliance will reimburse for CPT 90689. | |||
Are you currently enrolled in the VFC Program?
The Vaccines For Children (VFC) program is a federally funded program that provides vaccines at no cost to eligible children who might not otherwise be vaccinated because of inability to pay.
VFC Program Information
- Only children younger than age 19 are eligible for the VFC program
- Children are eligible if they are:
- Medicaid eligible or;
- Uninsured or;
- Underinsured or;
- American Indian/Native American
- Children are eligible if they are:
- When using VFC stock, append modifier SL to the vaccine code
- Modifier SL indicates VFC stock used and only allows reimbursement for the administration of the vaccine
Per Medi-Cal Guidelines, “Medi-Cal vaccine injection codes billed for recipients eligible to receive VFC program vaccines will be reimbursed only in documented cases of vaccine shortage, disease epidemic, vaccine delivery problems, or instances when the recipient does not meet the special circumstances required for VFC special-order vaccines. A provider’s non-enrollment in the VFC program is not a justified exception.
How to bill:
- Do not bill the CPT code with the SL modifier
- Document “non-VFC” in box 19 of the CMS claim form or box 80 of the UB-04 claim form
- All claims must be billed on UB-04, CMS-1500 or their electronic equivalent.
Send the claim to Sharlene Gianopoulos, Claims Operations Manager, at [email protected].
