Flu Vaccine Guidance

This year's guidelines from the Centers for Disease Control and Prevention (CDC) stress that all individuals over six months of age should receive the flu shot regardless of health status. This differs from previous years, when the CDC's Advisory Committee on Immunization Practices (ACIP) focused on high-risk patients.

For the 2011-2012 influenza season, a single flu vaccine covers the three most common flu strains in the northern hemisphere, including H1N1. Humana has compiled the following frequently asked questions and answers that may be useful for physicians and office personnel:

  1. What is Humana's coverage guidance for the flu vaccine?

    Following are coverage details for Humana members:

    • Commercial Fully Insured

      The flu vaccine may be covered under a member's medical or pharmacy benefit. Reimbursement is according to in- and out-of-network benefits. For more information, call the phone number on the back of the member's ID card.

    • HumanaOne®

      The flu vaccine may be covered for members depending on their individual HumanaOne plan. For more information, call the member / provider service phone number on the back of the member's ID card.

    • Administrative Services Only (ASO)

      The flu vaccine may be covered for members depending on their group-specific coverage. For more information, call the phone number on the back of the member's ID card.

    • Medicare

      Most Medicare members have access to the flu vaccine under their Medicare Advantage Prescription Drug (MAPD) Part B benefit. Humana Medicare members with Part D-only (pharmacy-only) coverage will not have coverage for the flu vaccine with their Humana benefit. Claims for the flu vaccine submitted for Humana Part D-only members will result in a denied claim. Part D-only members may be referred back to Medicare or to their medical carrier to determine how the vaccine is covered. Additionally, Limited Income Newly Eligible Transition beneficiaries are not eligible for the vaccine.

  2. What codes should be used for the flu vaccine?

    Health care providers should identify two codes for each vaccination, one administrative code and one vaccine code. One code should be selected from each of the following groups:

    • Administration codes for influenza vaccination include:

      G0008, 90471, 90472, 90473, 90474

    • Vaccine codes for influenza vaccination include:
      • 90654

        Influenza virus vaccine, split virus, preservative free, for intradermal use

        Note: 90654 became payable by the Centers for Medicare & Medicaid Services (CMS) on May 9, 2011.

      • 90655

        Influenza virus vaccine, split virus, preservative free, when administered to children 6-35 months of age, for intramuscular use

      • 90656

        Influenza virus vaccine, split virus, preservative free, when administered to individuals 3 years and older, for intramuscular use

      • 90657

        Influenza virus vaccine, split virus, when administered to children 6-35 months of age, for intramuscular use

      • 90658 until 12/31/2010

        Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use

        NOTE: Per CMS, claims with dates of service on or after January 1, 2011, will no longer allow CPT 90658 to be payable for Medicare (see Q2035 – Q2039). This code is still valid for commercial claims.

      • Q2035 beginning 1/1/2011

        Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Afluria)

      • Q2036 beginning 1/1/2011

        Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Flulaval)

      • Q2037 beginning 1/1/2011

        Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Fluvirin)

      • Q2038 beginning 1/1/2011

        Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Fluzone)

      • Q2039 beginning 1/1/2011

        Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Not Otherwise Specified)

      • 90660

        Influenza virus vaccine, live, for intranasal use

      • 90662

        Influenza virus vaccine, split virus, preservative free, enhanced immunogenicity via increased antigen content, for intramuscular use

  3. Is there an age limit?

    Children under the age of six months should not receive the vaccine; however, there is no upper age limit for the inactivated intramuscular influenza vaccination. The inactivated intradermal influenza vaccination is approved for use in adults 18 through 64 years of age.

    The Live Attenuated Influenza Vaccine (LAIV) is recommended for healthy people two through 49 years old, who are not pregnant and do not have certain health conditions.

    Children age six months through eight years should receive two doses of a 2011-2012 seasonal influenza vaccine if the following applies:

    • Their vaccination status is unknown, or
    • They did not receive at least one dose of the 2010-2011 seasonal influenza vaccine
  4. Can I charge a copayment to my Humana-covered patient?

    A: If the only service provided to the member that day is the flu immunization, a copayment is not allowed. However, if there are other services provided during the visit for which copayment is typically required, a copayment may be collected.

For questions about Humana's policies for flu vaccination coding or coverage, please call the member/provider service phone number on the back of the member's Humana ID card.

The CDC offers information regarding screening and managing patients, vaccine resources and patient education. For the most up-to-date information, please refer to the CDC clinician website.