BlueCross BlueShield of South Carolina provides coverage for the seasonal influenza virus vaccine and its administration as part of its preventive immunization services. We will pay for the administration of the seasonal flu vaccinations even if the vaccinations are rendered earlier in the year than normal. Typically payment is warranted for one vaccination per year. We cover additional influenza vaccines (i.e., the number of doses of a vaccine and/or the type of influenza vaccine) when they are deemed to be medical necessary. If it is necessary for our members to receive both seasonal flu vaccinations and Influenza A [H1N1] vaccinations, then we will pay for the administration of both vaccines.
Effective September 1, 2009, BlueCross BlueShield of South Carolina will pay for the administration of H1N1and the seasonal flu vaccination for all its fully insured members.
BlueCross will cover the administration of H1N1 and seasonal flu vaccination depending on the member’s preventive benefits.
Payment will not be made to providers for the office visit when the only purpose of the visit is to administer the seasonal and/or the H1N1 vaccine(s).
Payment for G9141, 90470 or 90473 (administration of H1N1, which includes physician counseling the patient/family) and G0008 (administration of the seasonal influenza vaccine) will be paid at the same rate of $3.00 established for 90471 (immunization administration including percutaneous, intradermal, subcutaneous or intramuscular injections).
Effective for dates of service on and after September 1, 2009, the following codes can be used to file claims for H1N1:
The H1N1 vaccine serum, syringes and needles will be paid for by the federal government and provided to state health departments which will be responsible for creating a distribution model for providing the vaccine in local communities.
Since the H1N1 vaccine will be made available at no cost to providers, BlueCross will not pay providers for the vaccine, only the administration. Providers do not need to place the G9142 or 90663 (H1N1 vaccine code) on the claim. If either the G9142 or 90663 code appears on the claim, only that claim line will be denied.
Here is the most recent information available on the recommended vaccine dosage and administration: