Superior HealthPlan Influenza Vaccine Recommendations and Billing Codes
Influenza Vaccine Recommendations and Billing Codes
Texas Medicaid considers the influenza season in the United States to be October through the end of May. The optimal time to receive the influenza vaccine is as early in the season as it is available. However, patients should continue to receive the influenza vaccine through March.
The flu vaccine is a benefit of Texas Medicaid and is available to Superior HealthPlan members at no cost. Members that qualify can also get the vaccine at no cost at many local pharmacies.
The Influenza vaccine should be administered annually to all children beginning at the age of 6 months. Children age 6 months through 8 years who are receiving influenza vaccine for the first time should be administered 2 doses (separated by at least 4 weeks). Administer 1 dose to those who are 9 years of age or older or those who are not receiving the vaccine for the first time.
Beginning at 6 months of age, all high-risk infants, including those who qualify for RSV prophylaxis and their caregivers should be immunized against influenza, unless influenza immunization is medically contraindicated in the case of a specific individual.
For most healthy, non-pregnant persons age 2 through 49 years, either Live-Attenuated Influenza Vaccine (LAIV) or Inactivated Influenza Vaccine (IIV) may be used. However, LAIV should not be administered to:
- those with asthma;
- children 2 through 4 years who had wheezing in the past 12 months; or
- those who have any other underlying medical conditions that predispose them to influenza complications.
For all other LAIV contraindications, see MMWR 2010; 59 (No. RR-8), available at www.cdc.gov/mmwr/pdf/rr/rr5908.pdf.
Following are a list of approved Influenza Codes:
- 90654, 90655*, 90656*, 90657*, 90658*, 90685*, 90687*, 90688; or
- 90660* with (90460/90461 or 90473/90474); or
- 90672* with (90460/90461 or 90471/90472); or
- 90673 with (90471/90472) ; or
- 90686* with (90460/90461 or 90471/90472)
Hospital-based RHCs must submit claims for pneumococcal and influenza vaccines as non- RHC services, under their hospital provider identifier.
For additional information, please contact Provider Relations.
* Indicates a vaccine or toxoid distributed through TVFC. Vaccines and toxoids available through TVFC for clients who are birth through 18 years of age will not be reimbursed through Texas Medicaid. These vaccines and toxoids will be processed as informational.