| All Alliance lines of business
(Effective Date September 1, 2020 thru June 30, 2021) |
|||
|---|---|---|---|
| For members linked to your practice, another PCP (no Referral needed), or administrative members: | |||
| Vaccine Name | Dosage | Age Group | CPT Code |
| Afluria® (IIV4) | 0.5 mL PFS 10-bx* | 3 Years & Older | 90686 |
| 5 mL MDV
24.5 mcg/dose |
6 months & older | 90688 | |
| 5 mL MDV
.25 mL/dose |
6 to 35 months | 90687 | |
| Afluria® Pediatric (IIV4) | 0.25 mL PFS 10-bx* | 6 to 35 months | 90685 |
| Fluad® (IIV) | 0.5 mL PFS 10-bx* | 65 years & older | 90653 |
| Fluad® (allV4) | 0.5 mL PFS 10-bx* | 65 years & older | 90694 |
| Fluarix® (IIV4) | 0.5 mL PFS 10-bx* | 6 months & older | 90686 |
| Flublok® (RIV4) | 0.5 mL PFS 10-bx* | 18 years & older | 90682 |
| Flucelvax® (ccIIV4) | 0.5 mL PFS 10-bx* | 4 years & older | 90674 |
| 5 mL MDV
25 mcg/dose |
4 years & older | 90756 | |
| FluLaval® (IIV4) | 0.5 mL PFS 10-bx* | 6 months & older | 90686 |
| FluMist® (LAIV4) | 0.2 mL spray 10-bx* | 2 to 49 years | 90672 |
| Fluzone® (IIV4) | 0.5 mL PFS 10-bx* | 6 months & older | 90686 |
| 0.5 mL SDV 10-bx* | 6 months & older | 90686 | |
| 5 mL MDV
25 mcg/dose |
6 months & older | 90688 | |
| 5 mL MDV
.25 mL/dose |
6 to 35 months | 90687 | |
| Fluzone® High-Dose (IIV) | 0.7 mL PFS 10-bx* | 65 years & older | 90662 |
*Preservative free
| Immunization Registries | |
|---|---|
| Vaccine Name | Immunization Service Name with CVX* |
| Afluria® (IIV4) | Influenza, injectable, quadrivalent, pres free (150) |
| Influenza, injectable, quadrivalent (158) | |
| Afluria® Pediatric (IIV4) | Influenza, injectable, quadrivalent, pres free, ped (161) |
| Fluad® (IIV) | Influenza, trivalent, adjuvanted (168) |
| Fluad® (allV4) | Influenza, injectable, quadrivalent, pres free (150) |
| Fluarix® (IIV4) | Influenza, injectable, quadrivalent, pres free (150) |
| Flublok® (RIV4) | Influenza , recombinant, quad, inject, pres free (185) |
| Flucelvax® (ccIIV4) | Influenza, injectable, MDCK, pres free, quadrivalent (171) |
| Influenza, injectable, MDCK, quadrivalent (186) | |
| FluLaval® (IIV4) | Influenza, injectable, quadrivalent, pres free (150) |
| FluMist® (LAIV4) | Influenza, live, intranasal, quadrivalent (149) |
|
Fluzone® (IIV4) |
Influenza, injectable, quadrivalent, pres free (150) |
| Influenza, injectable, quadrivalent, pres free (150) | |
| Influenza, injectable, quadrivalent, (158) | |
| Fluzone® High-Dose (IIV) | Influenza, high dose seasonal (135) |
*Correct CVX code for immunization registries is needed for Care Based Incentives (CBI).
