In alignment with our commitment to maintaining and ensuring affordable access to vaccines, we recently updated our Provider Manual’s vaccines section to reflect vaccine and administration coverage effective Sept. 1, 2025.
The updates were made to the following Provider Manual pages:
Note: we’ll continue cover the COVID-19 vaccine as preventive (without member cost share) for all members ages 6 months and older.
Flu vaccines and administration
The following note was added to the Provider Manual page: “Priority Health will only cover single dose preparations of the influenza vaccine.”
| Code | Update |
| 90612 | Added code, awaiting FDA approval |
| 90635 | Added code, awaiting FDA approval |
| 90657 | Not covered for HMO/EPO, POS, PPO plans |
| 90658 | Not covered for HMO/EPO, POS, PPO plans |
| 90661 | Single dose only for HMO/EPO, POS, PPO plans |
| 90673 | Updated age range to 9 years and older, from 18 years and older |
| 90749 | Explanatory notes must accompany claim. Bill listed code when available. |
| Q2035 |
|
| Q2038 |
|
| Q2039 |
|
| M0201 | Added code, covered for all plans |
Vaccine codes and coverage
| Code | Update |
| 90587 | Added code, not covered for all plans |
| 90593 | Covered for Medicaid & Healthy Michigan plan. Not covered for HMO/EPO, POS, PPO or Medicare Advantage plans. Coverage will be evaluated once FDA approval is granted. |
| 90619 | Age range changed to 6 weeks & older from 2 years & older |
| 90626 | Added code. Covered for Medicaid & Healthy Michigan plan. Not covered for HMO/EPO, POS, PPO or Medicare Advantage plans. |
| 90627 | Added code. Covered for Medicaid & Healthy Michigan plan. Not covered for HMO/EPO, POS, PPO or Medicare Advantage plans. |
| 90635 | Coverage will be evaluated once FDA approval is granted. |
| 90648 |
|
| 90653 | Added age range of 65 years and older |
| 90656 | Added age range of 6 months and older |
| 90657 |
|
| 90658 |
|
| 90660 | Added age range of 2-49 years |
| 90661 |
|
| Q2035 |
|
| Q2038 |
|
| Q2039 |
|
| 90673 | Updated age range to 9 years and older from 18 years and older |
| 90684 | Covered for Medicare Advantage plans |
| 90744 | Updated age range to 0-19 years from 0-18 years |
| 90746 | Covered for Medicaid & Healthy Michigan plans for adults only |
| 90758 | Added BN: ERVEBO |
| 90759 |
|
| 91304 | Updated to Nuvaxovid from Novavax |
| 91321 | Added BN: SPIKEVAX |
| 91322 | Added BN: SPIKEVAX |
| 91323 |
|
| 90382 | For Medicaid & Healthy Michigan plans, covered for children (VFC) but not for adults |