2008/2009 Influenza Billing & Reimbursement Information

1. 2008/2009 Influenza Billing & Reimbursement Information August 27, 2008

2. Vaccine Administration • Codes • 90465 Under age 8 injection • 90467 Under age 8 intranasal • 90471 Over age 8 injection • 90473 Over age 8 intranasal • Reimbursement • $15.50

3. Influenza Vaccine • Codes • 90655 Preservative free, under age 3 • 90656 Under age 3 • 90657 Preservative free, over age 3 • 90658 Over age 3 • 90660 Intranasal, all ages • Reimbursement • State Supplied : $0.50 • Non-State Supplied : AWP

4. Billing Information • Claim Form • Use the appropriate 1500, UB-92 or electronic claim form. (No roster billing) • Administration • Bill an administration code for all immunizations, i.e. State supplied and non-State supplied. • Vaccine • Bill the base CPT code for State supplied vaccine • Add a 22 modifier for non-State supplied vaccine.

5. Other Key Points • Flu Immunization is covered for all BCBSRI lines of business; • There is no co-payment or coinsurance for immunizations administered in a physician office; • A separately identifiable E&M service will be subject to an office visit co-payment) • A coinsurance and/or deductible will apply for members whose ID #s begin with CZF (Citizens Bank). • No direct reimbursement for pharmacists.

6. Contact Information • Professional Providers • Physician & Provider Service Call Center • (401) 274-4848 • 1-800-230-9050 • Institutional Providers • Facility Representative • Larry Ross • (401) 459-1288 • email larry.ross@bcbsri.org