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Wellmark Expands Coverage of H1N1 Flu Vaccine Administration

November 6, 2009

Effective with date of service November 6, 2009, Wellmark will begin covering the cost of the H1N1 flu immunization administration for some members who do not have immunization benefits.

Please review the following information for those members who do not otherwise have immunization coverage, or have coverage that includes well-child benefits (to age 7 years) only:

• The expanded coverage will include only the H1N1 immunization administration. No other immunizations are included.
• The coverage is temporary, and will be discontinued when the Centers for Disease Control and Prevention (CDC) announces an end date for the 2009–2010 flu season.
• The administration of the H1N1 vaccine will be covered as any other injection administration, such as an allergy injection. This means the member may be responsible for all or a portion of the cost (e.g., deductibles, coinsurance, copayments).
• Even with this expanded coverage, some Wellmark members will not be covered for the H1N1 immunization administration.

NOTE: The temporary coverage will not be reflected on our secured View Eligibility and Benefits online tools. Because some members will not have coverage for the H1N1 immunization administration, we suggest you file a claim for all Wellmark members who receive the H1N1 vaccination.

Members with Preventive Benefits

For members covered by preventive care benefits, the administration of the H1N1 vaccine will continue to be covered according to their normal plan cost-sharing (e.g., deductibles, coinsurance, copayments). Coverage of the administration is also subject to any applicable preventive care benefit maximums.

As always, you will be able to check these benefits using our secured online tools.

Coding

Report the administration of the H1N1 vaccine using CPT^®* code 90470,¹ or HCPCS G9141:

• 90470 – H1N1 immunization administration (intramuscular, intranasal), including counseling when performed
• G9141 – Influenza A (H1N1) immunization administration (includes the physician counseling the patient/family)
• Wellmark does not cover a separate charge for the H1N1 vaccine itself (CPT code 90663 or HCPCS G9142), because the vaccine is being supplied at no cost to providers.

Seasonal and H1N1 Vaccinations

If providing both seasonal and H1N1 vaccine during the same visit:

• List the seasonal influenza virus vaccine with the appropriate CPT code (90660–90662) and its administration (90471)
• Code the H1N1 administration using 90470 or G9141.

More information on the H1N1 flu and the associated vaccine can be found at the CDC Web site at http://www.cdc.gov//h1n1flu/.

*Current Procedural Terminology © 2009 American Medical Association. All Rights Reserved. CPT^® is a trademark of the American Medical Association.

¹CPT code 90470 was released on September 28, 2009.