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Urgent Care Centers eligible to provide Influenza Vaccines

Effective November 15, 2020, participating Urgent Care Centers (UCCs) are eligible to provide and receive reimbursement for the administration of influenza vaccines to Horizon BCBSNJ members enrolled in fully insured commercial plans, Medicare Advantage plans, and Administrative Services Only (ASO) employer group plans including New Jersey State Health Benefits Program/School Employees’ Health Benefits Program (SHBP/SEHBP) plans.

A flu vaccine will only be considered for separate reimbursement if it is the only service the member receives during a particular visit. A flu vaccine provided during a visit to address other medical issues during which other services are provided will be considered reimbursed in the UCC’s global payment. Members will be responsible to pay their regular cost sharing.

This remains in effect as long as we’re in a Public Health Emergency due to COVID-19 or until Horizon BCBSNJ notifies participating Urgent Care Centers otherwise.

Members can locate Urgent Care Centers that participate with their plan by searching the Urgent Care Services category within our online Doctor & Hospital Finder.

The following influenza vaccine codes are considered for reimbursement when provided by a participating Urgent Care Center November 15, 2020 and after.

Code Description
90630 Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, for intradermal use
90644 Meningococcal conjugate vaccine, serogroups C & Y and Haemophilus influenzae type b vaccine (Hib-MenCY), 4 dose schedule, when administered to children 6 weeks-18 months of age, for intramuscular use
90647 Haemophilus influenzae type b vaccine (Hib), PRP-OMP conjugate, 3 dose schedule, for intramuscular use
90648 Haemophilus influenzae type b vaccine (Hib), PRP-T conjugate, 4 dose schedule, for intramuscular use
90653 Influenza vaccine, inactivated (IIV), subunit, adjuvanted, for intramuscular use
90654 Influenza virus vaccine, trivalent (IIV3), split virus, preservative-free, for intradermal use
90655 Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, 0.25 mL dosage, for intramuscular use
90656 Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, 0.5 mL dosage, for intramuscular use
90657 Influenza virus vaccine, trivalent (IIV3), split virus, 0.25 mL dosage, for intramuscular use
90658 Influenza virus vaccine, trivalent (IIV3), split virus, 0.5 mL dosage, for intramuscular use
90660 Influenza virus vaccine, trivalent, live (LAIV3), for intranasal use
90661 Influenza virus vaccine, trivalent (ccIIV3), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage, for intramuscular use
90662 Influenza virus vaccine (IIV), split virus, preservative free, enhanced immunogenicity via increased antigen content, for intramuscular use
90664 Influenza virus vaccine, live (LAIV), pandemic formulation, for intranasal use
90666 Influenza virus vaccine (IIV), pandemic formulation, split virus, preservative free, for intramuscular use
90667 Influenza virus vaccine (IIV), pandemic formulation, split virus, adjuvanted, for intramuscular use
90668 Influenza virus vaccine (IIV), pandemic formulation, split virus, for intramuscular use
90672 Influenza virus vaccine, quadrivalent, live (LAIV4), for intranasal use
90673 Influenza virus vaccine, trivalent (RIV3), derived from recombinant DNA, hemagglutinin (HA) protein only, preservative and antibiotic free, for intramuscular use
90674 Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage, for intramuscular use
90682 Influenza virus vaccine, quadrivalent (RIV4), derived from recombinant DNA, hemagglutinin (HA) protein only, preservative and antibiotic free, for intramuscular use
90685 Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, 0.25 mL, for intramuscular use
90686 Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, 0.5 mL dosage, for intramuscular use
90687 Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.25 mL dosage, for intramuscular use
90688 Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.5 mL dosage, for intramuscular use
90689 Influenza virus vaccine quadrivalent (IIV4), inactivated, adjuvanted, preservative free, 0.25 mL dosage, for intramuscular use
90756 Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, antibiotic free, 0.5mL dosage, for intramuscular use
Q2034 Influenza virus vaccine, split virus, for intramuscular use (Agriflu)
Q2035 Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (AFLURIA)
Q2036 Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (FLULAVAL)
Q2037 Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (FLUVIRIN)
Q2038 Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Fluzone)
Q2039 Influenza virus vaccine, not otherwise specified

Claim reimbursement is subject to member eligibility and all member and group benefit limitations, conditions and exclusions.

Additional options to help your patients get their flu shots
Many pharmacies and other retailers can also provide flu shots at no cost for people with medical coverage through Horizon BCBSNJ. Other vaccines can also be administered including shingles, hepatitis A and B, pneumococcal and human papillomavirus1 (HPV).

Learn more about which pharmacies provide no-cost flu shots and other vaccines for Horizon BCBSNJ members.

CPT® is a registered mark of the American Medical Association.

Published on: October 26, 2020, 12:14 p.m. ET
Last updated on: October 30, 2020, 10:14 a.m. ET