Oct.16, 2019
The Centers for Disease Control and Prevention (CDC) recommends yearly flu shots for all patients 6 months and older without vaccine contraindication. Providers may administer any U.S. Food and Drug Administration (FDA) approved, age-appropriate flu shot. Remember to review the current flu vaccine product table for the most recent updates on available products and their approved age ranges.1
What’s different this flu season?1
- All standard adult and pediatric dose flu vaccines will be quadrivalent; no trivalent regular dose flu shots are available this season.
- Afluria Quadrivalent® is now licensed for children 6 months of age and older.
- Baloxavir (XofluzaTM) is a new single-dose antiviral drug approved by the FDA for people 12 years and older who have had flu symptoms for less than 48 hours. Baloxavir (Xofluza) is not a substitute for early vaccination with the annual seasonal flu vaccine.
Reminders this Flu Season2
- Trivalent high dose or adjuvant containing flu vaccines for the elderly (65 and older) are made specifically to create a better or stronger immune response.
- Oseltamivir (Tamiflu®) is used for the treatment of influenza for patients 2 weeks or older who have had flu symptoms for less than 48 hours, as well as the prophylaxis of influenza in patients 1 year and older. Oseltamivir (Tamiflu) is not a substitute for early vaccination with the annual seasonal flu vaccine.
- Oseltamivir (Tamiflu) is also available as a generic medication, which may have a lower cost to the member compared to a branded medication.
Coding Reminders
- Please file your claims with correct coding*
- The American Academy of Pediatrics (AAP) coding chart
recommends which billing code to use based on the vaccine administered. (This chart is not a comprehensive list.)
- The American Academy of Pediatrics (AAP) coding chart
- Code descriptions are specific to the vaccine product.
- Code descriptions may include:
- Dosage amounts
- Trivalent versus quadrivalent formulations
- Distinctive features (i.e., preservative-free, split virus, recombinant DNA, cell cultures or adjuvanted).
*Correct coding requires services to be reported with the most specific code available that appropriately describes the service.
1CDC, Frequently Asked Influenza (Flu) Questions: 2019-2020 Season , Sept. 16, 2019.
2CDC, Antiviral Drugs for Seasonal Influenza: Additional Links and Resources , Nov. 29, 2018.
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The above material is for informational purposes only and is not a substitute for the independent medical judgment of a physician or other health care provider. Physicians and other health care providers are encouraged to use their own medical judgment based upon all available information and the condition of the patient in determining the appropriate course of treatment. References to third party sources or organizations are not a representation, warranty or endorsement of such organizations. Any questions regarding those organizations should be addressed to them directly. The fact that a service or treatment is described in this material is not a guarantee that the service or treatment is a covered benefit and members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions. Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider.