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Provider Digest | Issue 6

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2022-2023 influenza billing/coding updates

Vaccine composition for the 2022-23 U.S. influenza season

The committee recommended that the quadrivalent formulation of egg-based influenza vaccines for the U.S. 2022-2023 influenza season contain the following:

  • A/Victoria/2570/2019 (H1N1) pdm09-like virus.
  • A/Darwin/9/2021 (H3N2)-like virus.
  • B/Austria/1359417/2021-like virus (B/Victoria lineage).
  • B/Phuket/3073/2013-like virus (B/Yamagata lineage).

The committee recommended that the quadrivalent formulation of cell- or recombinant-based influenza vaccines for the U.S. 2022-2023 influenza season contain the following:

  • A/Wisconsin/588/2019 (H1N1) pdm09-like virus.
  • A/Darwin/6/2021 (H3N2)-like virus.
  • B/Austria/1359417/2021-like virus (B/Victoria lineage).
  • B/Phuket/3073/2013-like virus (B/Yamagata lineage).

Note changes from the 2021-22 vaccine components:

  1. A(H3N2) component was changed to an A/Darwin/9/2021 (H3N2)–like virus for egg-based vaccines.
  2. An A/Darwin/6/2021 (H3N2)-like virus for cell-based or recombinant vaccines.
  3. The B/Victoria component recommendation was changed to a B/Austria/1359417/2021-like virus.

(Morbidity and Mortality Weekly Report, July 22, 2022 / 71(29);913-919)

All Alliance lines of business

(Effective Date September 1, 2022 through June 30, 2023)

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 and older 90686
5 mL MDV

24.5 mcg/dose

3 years and older 90688
Afluria® Pediatric (IIV4) 0.25 mL PFS 10-bx* 6 to 35 months 90687
Fluad® (IIV) 0.5 mL PFS 10-bx* 65 years and older 90694
Fluarix® (IIV4) 0.5 mL PFS 10-bx* 6 months and older 90686
Flublok® (RIV4) 0.5 mL PFS 10-bx* 18 years and older 90682
Flucelvax® (ccIIV4)

 

0.5 mL PFS 10-bx* 2 years and older 90674
5 mL MDV

25 mcg/dose

2 years and older 90756
FluLaval® (IIV4) 0.5 mL PFS 10-bx* 6 months and 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 and older 90686
0.5 mL SDV 10-bx* 6 months and older 90686
5 mL MDV

25 mcg/dose

6 to 35 months 90687
5 mL MDV

25 mcg/dose

3 years and older 90688
Fluzone® High-Dose (IIV) 0.7 mL PFS 10-bx* 65 years and older 90662

*Correct CVX code for immunization registries is needed for the Care Based Incentive (CBI) program.

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 (158)
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)

Vaccines for Children Program

Qhov kevpab cuam 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.

Here are some key highlights from the VFC program:

  • Only children under the age of 19 are eligible for the VFC program.
  • Children are eligible if they are any of the following:
    • Medicaid eligible.
    • Uninsured.
    • Underinsured.
    • 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 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 if you are not a VFC provider:

  • 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.

Claim forms

All claims must be billed on UB-04, CMS-1500 or their electronic equivalent.

Register for September Care-Based Incentive Workshop

Registration is now open for the Alliance’s 2023 Care-Based Incentive (CBI) Workshop Webinar. The webinar will be held Sept. 14, noon-1:30 p.m., covering information on:

  • New and updated CBI programmatic, FFS and exploratory measures like the new $200 Fee-For-Service Measure for Adverse Childhood Experiences (ACEs) Training and Attestation.
  • Effective communication tools.
  • Alliance resources.

Who should attend:

  • Primary care providers.
  • Medical assistants.
  • Front office and billing staff, office managers.

To learn more and register, please visit the event registration page or contact a Provider Relations Representative at 800-700-3874, ext. 5504.

You can also find more information about the CBI program on our website.

September 2022 Virtual Immunization Training

On Sept. 8, Central California Alliance for Health is partnering with the California Department of Public Health (CDPH) to host an immunization training for our three counties.

Discussion topics will include:

  • Updates from the Alliance and Merced County. Alliance staff will share immunization rates, resources and immunization-related Cov Kev Txhawb Zog Rau Kev Saib Xyuas.
  • Flu and COVID-19 vaccine training with Steven Vantine, Education Consultant with CDPH.

We hope you join us! This is a virtual training, so please extend this invite to others you feel would benefit from it.

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  • Merced County: Please contact Veronica Lozano, QI Program Advisor II with the Alliance, at [email protected].
  • Monterey and Santa Cruz counties: Please contact Jo Pirie, QI Program Advisor II with the Alliance, at [email protected].

Please register today!