. View Pharmacy benefit information, newsletters and important pharmacy news updates.Flu Vaccine Season Information
Flu Vaccine Billing Guidelines & Related Services
The Health Plan will accept all CPT codes and Medicare codes were applicable.
Each line of business has special billing reimbursement guidelines are as follows:
- Commercial or HMO: vaccines are billed to The Health Plan
- Medicare SecureCare: vaccine are billed to The Health Plan
- Mountain Health Trust/WV Medicaid: vaccines are billed to the State Bureau of Medical Services. Vaccines for these member are provided at no cost by the State if participating in the VFC- Vaccine For Children program. Check with your Provider or refer these members to one of the local Health Departments.
- Self Funded Employer Groups: have distinct benefit guidelines that could preclude payment for vaccination services. Please contact the Health Plan directly Customer Service Department at 1.800.624.6961, ext. 7902 or 740.695.7902.
Non Covered Services
- 90662 High Dose Fluzone is NOT covered by The Health Plan based on current documentation provided by the CDC. Below is statement below on the CDC website located at www.cdc.gov/flu/protect/vaccie/qa_fluzone.
“CDC and the Advisory Committee on Immunization Practices (ACIP) recommends flu vaccination as the first and most important step in protecting against the flu, however, neither CDC nor ACIP is expressing a preference of one vaccine over another at this time.”last updated on CDC website July 6, 2011.
- 87804 Infectious agent antigen detection: Influenza is NOT covered by The Health Plan is not medically necessary in the immediate care of a patient. During influenza season, testing of selected patients presenting with respiratory illnesses compatible with influenza can help establish whether influenza is present in a specific patient populations and help health-care providers determine how to use their clinical judgment for diagnosing and treating respiratory illness. Testing need not be done for all patients. If the services were medically necessary, please bill the service and all applicable diagnosis to explain the medical need.
- Visit CDC website: http://www.cdc.gov/h1n1flu/guidance/diagnostic_tests.htm
- Visit West Virginia Bureau for Public Health-Health Advisory # 41 at http://www.dhhr.wv.gov/oeps/disease/Documents/WV%20HAN%20Advisory%200041-2011-01-10%20Flu%20RIDTs.pdf