MassHealth Flu Vaccine Procedure Codes effective July 1 2014.pdf

CODE Vaccine Type DESCRIPTION

90460 $23.29

Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; first vaccine/toxoid component

90460_SL* $23.29

Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; first vaccine/toxoid component (state supplied vaccine) (Only to be used for administration of pediatric vaccines for individuals ages 18 years and under provided at no cost by the Massachusetts Department of

Public Health, including those administered under the Vaccine for Children (VFC) Program)

(Not in conjunction with an office visit or other outpatient visit)

90461 $0.00

Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; each additional vaccine/toxoid component (List separately in addition to code for primary procedure)

90461_SL* $0.00

Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; each additional vaccine/toxoid component (List separately in addition to code for primary procedure) (state supplied vaccine) (Only to be used for administration of pediatric vaccines for individuals ages

18 years and under provided at no cost by the Massachusetts Department of Public Health, including those administered under the Vaccine for Children (VFC) Program) (Not in conjunction with an office visit or other outpatient visit)

90471 $18.23 Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); one vaccine (single or combination vaccine/toxoid)

90471-SL*

Age 0><18 $23.29

Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 vaccine (single or combination vaccine/toxoid)

90471-SL*

Age 19+ $15.78

Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 vaccine (single or combination vaccine/toxoid)

90472 $8.83

Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); each additional vaccine (single or combination vaccine/toxoid) (List separately in addition to code for primary procedure)

90472-SL*

Age 0><18 $23.29

Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); each additional vaccine (single or combination vaccine/toxoid) (List separately in addition to code for primary procedure)

90472-SL*

Age 19+ $8.83

Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); each additional vaccine (single or combination vaccine/toxoid) (List separately in addition to code for primary procedure)

90473 $18.23 Immunization administration by intranasal or oral route; one vaccine (single or combination vaccine/toxoid)

90473-SL*

Age 0><18 $23.29

Immunization administration by intranasal or oral route; 1 vaccine (single or combination vaccine/toxoid)

90473-SL*

Age 19+ $15.78

Immunization administration by intranasal or oral route; 1 vaccine (single or combination vaccine/toxoid)

90474 $8.83 Immunization administration by intranasal or oral route; each additional vaccine (single or combination vaccine/toxoid) (List separately in addition to code for primary procedure)

90474-SL*

Age 0><18 $23.29

Immunization administration by intranasal or oral route; each additional vaccine (single or combination vaccine/toxoid) (List separately in addition to code for primary procedure)

90474-SL*

Age 19+ $8.83

Immunization administration by intranasal or oral route; each additional vaccine (single or combination vaccine/toxoid) (List separately in addition to code for primary procedure)

90655 $15.45 Fluzone, 0.25 pre-filled syringe (PFS)

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

90656 $12.54 Any formulation in pre-filled syringes or single-dose vials

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

90657 $5.68 Fluzone, multi-dose vial

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

90658 $11.37 Any formulation in a multi-dose vial

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

90660 $22.32 FluMist Influenza virus vaccine, live, for intranasal use

90672

Age 19><49 **I.C. Influenza virus vaccine, quadrivalent, live, for intranasal use for 19+ and up to 49 yeas of age

90686

Age 19+ **I.C.

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

90688

Age 19+ **I.C.

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

F lu

A d m in is tr a ti o n

C o d es

MassHealth Flu Vaccine Program Procedure Codes for Public Providers

(Local Public Health Departments and Public School Districts ONLY)

F lu

V a cc in e C o d es Rates effective

July 1, 2014

* SL: to be used only if administering State-supplied vaccine

N O

T t o b e u se d b y P ro v id er s u si n g D

P H

-s u p p li ed v a cc in es

Available for free from MDPH

Immunization

Program (DPH-supplied) for ages

0><18

** I.C. (individual consideration) - claims to be priced upon receipt of manufacturer invoice for the exact number of doses and price per dose