This article is for health care providers who bill for flu vaccinations.
Cold and flu season is here, and we need your help protecting our members – your patients. As you know, your patients can protect themselves and everyone around them by receiving the flu vaccine.
Here is some important information about Blue Cross coverage and billing information for the flu vaccine, and several reminders of its importance.
What Blue Cross covers
Blue Cross follows the CDC and Advisory Committee on Immunization Practices recommendations for the 2023-2024 season.
- In-network. We cover the cost of all CDC-approved vaccines, based on availability, when administered by an in-network provider.
- Out-of-network. We cover flu vaccines performed by non-participating providers only for Medicare Advantage members.
Billing information
- Bill only the applicable CPT or HCPCS codes listed on your fee schedule.
- We provide separate reimbursement for both the COVID-19 vaccine and flu vaccine (see below for the administration), even if a member receives both during the same office visit.
- We provide separate reimbursement for the administration (injection) of routine pediatric immunizations (0-19 years) even if it is part of an office visit.
- For members ages 20 and older, we do not separately reimburse for the administration (injection) of immunizations when billed with an office visit.
- See our Flu Season fact sheet for more information.
Protecting each other
Remind your patients that the flu vaccine protect not just themselves, but everyone around them and especially those who have the highest risk.
As you know, getting a flu shot reduces the risk of:
- Getting the flu or having a severe case of it
- Spreading the flu to family, friends, and community
- Being hospitalized
- Contracting COVID-19 and the flu (two life-threatening diseases) simultaneously
The risk of COVID-19 remains
While the COVID-19 public health emergency expired earlier this year, COVID-19 remains a risk to patients. The CDC recommends an updated COVID-19 vaccine or booster to protect against potentially serious outcomes, including Long COVID.
CDC recommendations for 2023-2024
- The Centers for Disease Control and Prevention (CDC) recommends everyone over the age of six months receive routine flu vaccinations, unless there are contraindications, such as a history of severe, life-threatening allergies to the flu vaccine.
- While vaccination should ideally occur by the end of October, it can occur as long as influenza viruses are circulating.
High-risk groups include:
- Adults 65 years and older
- Children younger than two years old
- People with weakened immune systems due to disease or medications
- Those who are pregnant or are up to two weeks postpartum
- People who live in nursing homes and long-term care facilities
Resources
- See our Flu Season fact sheet (link to fact sheet) and Immunizations Payment Policy (log in required) for more details about vaccines and how to bill for vaccine administration.
- Visit the CDC website flu page.
- For information on where to get a flu shot, your patients can visit our Find a Doctor & Estimate Costs tool (bluecrossma.com/findadoctor), bcbs.com, or vaccines.gov/get-vaccinated/where.
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