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2018-2019 Influenza Season Billing/Coding Updates

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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
  • 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]