Special Coverage for H1N1 Vaccine

With the impending delivery of the new vaccine for the H1N1 flu virus, Blue Cross and Blue Shield of Texas (BCBSTX) wants to make our network physicians aware of our policy concerning coverage of charges for administering the vaccine to BCBSTX members.

Some members' health plan medical benefits may not cover vaccination charges. BCBSTX has implemented a policy to cover the administration of the vaccine for members of our fully insured health plans without regard to whether their current plan covers vaccinations. We will cover this service without applying the benefit payment to their deductible or coinsurance.

We will also work proactively with all of the employers we work with who have self-funded employer health benefit plans, recommending that they adjust their benefit coverage to also cover administration of the vaccine.

In order to benefit from this special coverage, a member must receive the vaccination from a BCBSTX network provider. When using a provider that is not in the BCBSTX network, normal benefits coverage will apply.

Coverage will be available for those five priority populations that the Centers for Disease Control and Prevention (CDC) recommends receive the vaccine first:

  • Pregnant women.
  • People who live with or care for children younger than 6 months of age.
  • Health care and emergency medical services personnel.
  • Persons between the ages of 6 months through 24 years.
  • People age 25 through 64 who have chronic health disorders or compromised immune systems.

Please use the following codes for the H1N1 vaccine:

  • 90663 — Influenza virus vaccine, pandemic formulation, H1N1
  • 90470 — H1N1 immunization administration (intramuscular, intranasal), including counseling when performed

Because the vaccine is being supplied by the federal government at no charge, BCBSTX will allow $.01 for CPT code 90663. A claim for the vaccine (90663) is required in order to process the claim for administration (90470).