| All Alliance lines of business
(Effective Date September 1, 2021 thru June 30, 2022) |
|||
|---|---|---|---|
| Applies to members linked to your practice, non-linked members (no Referral required) 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 |
3 Years & Older | 90688 | |
| Afluria® Pediatric (IIV4) | 0.25 mL PFS 10-bx* | 6 to 35 months | 90685
90687 |
| Fluad® (IIV) | 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* | 2 years & older | 90674 |
| 5 mL MDV
25 mcg/dose |
2 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 to 35 months | 90687 | |
| 5 mL MDV
25 mcg/dose |
3 Years & Older | 90688 | |
| Fluzone® High-Dose (IIV) | 0.7 mL PFS 10-bx* | 65 years & older | 90662 |
| 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 (144) |
| Fluad® (allV4) | Influenza, injectable, quadrivalent, pres free (205) |
| 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, (158) | |
| Fluzone® High-Dose (IIV) | Influenza, high dose seasonal (197, 135) |
*Correct CVX code for immunization registries is needed for Care Based Incentives (CBI).
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.
Information on the VFC Program:
- Only children less 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
- When using VFC stock, append modifier SL to the vaccine code
- Modifier SL indicates VFC stock used & only allows reimbursement for the administration of 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.”
However, the Alliance will make an exception for non VFC providers. 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
- Send the claim to CCAH Attention: Sharlene Gianopoulos
Claim forms:
All claims must be billed on UB-04, CMS-1500 or their electronic equivalent.
