Flu Vaccinations: A Simple Way to Save Lives

The CDC recommends that everyone 6 months of age and older get an annual flu vaccine.

The 2016 – 2017 trivalent seasonal flu vaccine will cover the three flu strains that research suggests will be most common in the northern hemisphere:

  • A/California/7/2009 (H1N1)pdm09-like virus
  • A/Hong Kong/4801/2014 (H3N2)-like virus
  • B/Brisbane/60/2008-like virus (B/Victoria lineage)

A quadrivalent vaccine also is available that will include the B/Phuket/3073/2013-like virus (B/Yamagata lineage).

Other vaccine details for the 2016 – 2017 flu season:

  • Intramuscular (IM) vaccines will be available in both trivalent and quadrivalent formulations. All high-dose IM vaccines will be trivalent this season.
  • A jet injector can be used for delivery of AFLURIA® for people 18 to 64 years old.
  • All intradermal vaccines will be quadrivalent.

Based on data showing poor or relatively lower effectiveness of the live attenuated influenza vaccine (LAIV), the CDC’s Advisory Committee on Immunization Practices (ACIP) determined that (LAIV), also known as the “nasal spray” flu vaccine, should not be used during the 2016-2017 flu season.

Flu season typically begins in early fall and likely will hit its peak in January and February. In fact, recent Recent Humana research has suggested that getting a flu vaccination before Dec. 15 further lessens individuals’ chances of getting the flu. This short podcast discusses the findings.

Humana encourages immunization of all people; however, the CDC recommends special emphasis on vaccinating the following people because of their increased risk of infections and associated complications:

  • Pregnant women
  • Children younger than 5, but especially children younger than 2 years old
  • People 50 years of age and older
  • People of any age with certain chronic medical conditions, including asthma, diabetes and chronic lung disease
  • People of any age who have immunosuppression
  • People who live in nursing homes and other long-term care facilities
  • People who live with or care for those at high risk for complications from flu, including:
    • Health care workers
    • Household contacts of people at high risk for complications from the flu
    • Household contacts and out-of-home caregivers of children less than 6 months of age (these children are too young to be vaccinated)

It is also important that dates of vaccination are recorded, not only by practices, but also by patients.

More information is available on www.flu.gov, on the "Planning & Preparedness" tab under the "Health Professionals" option from the drop-down menu. Additional resources, such as print materials and video and audio tools, can be found on the Centers for Disease Control and Prevention website at http://www.cdc.gov/flu/freeresources/index.htm.

Flu and pneumonia vaccinations are key to patient health and thus have become important quality metrics for programs such as the Healthcare Effectiveness Data and Information Set (HEDIS) and the Consumer Assessment of Healthcare Providers and Systems (CAHPS). Learn more about pneumonia vaccination.

Vaccine coverage and codes:

In order to help ensure correct billing and payment, two codes are needed for each vaccination claim: one administrative code and one vaccine code. One code should be selected from each of the following groups:

Administration codes for influenza vaccination include:

  • 90471, 90472, 90473, 90474
  • Medicare: G0008, G8482

Vaccine codes for influenza vaccination include:

  • CPT codes: 90630, 90653, 90654, 90655, 90656, 90657, 90658, 90660, 90661, 90662, 90664, 90672, 90673, 90674, 90682, 90685, 90686, 90687, 90688
  • HCPCS codes: Q2034, Q2035, Q2036, Q2037, Q2038, Q2039

Humana coverage guidelines for flu vaccine

  • Commercial Fully Insured — The flu vaccine may be covered 100 percent for members, depending on their group plan.
  • HumanaOne® — The flu vaccine is covered at a $0 copay for all HumanaOne plan members.
  • Administrative Services Only (ASO) — Individual self-insured groups provide Humana direction about coverage.
  • Medicare Advantage and Prescription Drug Plan — 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 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 (LINET) members are not eligible for the vaccine; their claims will not be covered.

Questions about Humana's policies for flu vaccination coding or coverage may be directed to the member/health care provider service phone number on the back of the member's Humana ID card.