- Self-funded plan coverage will vary by employer group, depending on purchase of coverage for general immunizations, flu shots and pharmacy benefits. Self-funded plans may also place additional restrictions on member use of out-of-network providers.
- Coinsurance and out-of-network benefits may apply. Reference plan documents for details.
- Vaccine shortages: In the event of a vaccine shortage, Priority Health will issue written guidelines and post them on this website. Note: A shortage is not the same as a delay from your vendor.
Jump down to Coverage by location
Flu vaccine coverage by plan, effective 09/01/2024
Child = 0-18 years Adult = 19 + years
Codes | Description | HMO/EPO, POS, | Medicaid & Healthy Michigan Plan | Medicare Advantage plans |
---|---|---|---|---|
90637 | Influenza virus vaccine, quadrivalent (qIRV), mRNA; 30 mcg/0.5 mL dosage, for intramuscular use Awaiting FDA approval | NO | NO | NO |
90638 | Influenza virus vaccine, quadrivalent (qIRV), mRNA; 60 mcg/0.5 mL dosage, for intramuscular use Awaiting FDA approval | NO | NO | NO |
90653 | Influenza virus vaccine, inactivated (IIV), subunit, adjuvanted, for intramuscular use | Covered | Adults: Covered | Covered |
90655 | Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, 0.25mL dosage, for intramuscular use | N/A | N/A | N/A |
90656 | Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, for 0.5mL dosage, for intramuscular use | Covered | Adults: Covered | Covered |
90657 | Influenza virus vaccine, trivalent (IIV3), split virus, 0.25mL dosage, for intramuscular use | Covered | Adults: Covered | Covered |
90658 | Influenza virus vaccine, trivalent (IIV3), split virus, 0.5mL dosage, for intramuscular use | Covered | Adults: Covered | Covered |
90660 | Influenza virus vaccine, trivalent (LAIV3), live, for intranasal use | Covered | Adults: Covered | Covered |
90661 | Influenza virus vaccine (ccIIV3), derived from cell cultures, subunit, preservative and antibiotic free, 0.5mL dosage, for intramuscular use | Covered | Adults: Covered | Covered |
90662 | Influenza virus vaccine (IIV), split virus, preservative free, enhanced immunogenicity via increased antigen content, for intramuscular use | Covered | Covered | Covered |
90664 | Influenza virus vaccine, live (LAIV) pandemic formulation, for intranasal use | N/A | N/A | N/A |
90666 | Influenza virus vaccine (IIV), pandemic formulation, split virus, preservative free, for intramuscular use | N/A | N/A | N/A |
90667 | Influenza virus vaccine (IIV), pandemic formulation, split virus, adjuvanted, for intramuscular use | N/A | N/A | N/A |
90668 | Influenza virus vaccine (IIV), pandemic formulation, split virus, for intramuscular use | N/A | N/A | N/A |
90672 | Influenza virus vaccine, quadrivalent, live (LAIV4), for intranasal use | N/A | N/A | N/A |
90673 | Influenza virus vaccine, trivalent (RIV3), derived from recombinant DNA (RIV3), hemagglutinin (HA) protein only, preservative and antibiotic free, for intramuscular use | Covered | Adults: Covered | Covered |
90674 | Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage, for intramuscular use | N/A | N/A | N/A |
90682 | Influenza virus vaccine, quadrivalent (RIV4), derived from recombinant DNA, hemagglutinin (HA) protein only, preservative and antibiotic free, for intramuscular use | N/A | N/A | N/A |
90685 | Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, 0.25 mL dosage, for intramuscular use | N/A | N/A | N/A |
90686 | Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, 0.5mL dosage, for intramuscular use | N/A | N/A | N/A |
90687 | Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.25mL dosage, for intramuscular use | N/A | N/A | N/A |
90688 | Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, 0.5mL dosage, for intramuscular use | N/A | N/A | N/A |
90689 | Influenza virus vaccine quadrivalent (IIV4), inactivated, adjuvanted, preservative free, 0.25 mL dosage, for intramuscular use | N/A | N/A | N/A |
90694 | Influenza virus vaccine, quadrivalent (allV4), inactivated, adjuvanted, preservative free, 0.5 mL dosage, for intramuscular use | N/A | N/A | N/A |
90695 | Influenza virus vaccine, H5N8, derived from cell cultures, adjuvanted, for intramuscular use Awaiting FDA approval | N/A | N/A | N/A |
90749 | Unlisted Vaccine/Toxoid | Covered | Adults: Covered | Covered |
90756 | Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, antibiotic free, 0.5mL dosage, for intramuscular use | N/A | N/A | N/A |
Q2034 | Influenza virus vaccine, split virus, for intramuscular use (AGRIFLU) | N/A | N/A | N/A |
Q2035 | Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use | Covered | Adults: Covered | Covered |
Q2036 | Influenza virus vaccine, split virus, for use in individuals 3 years of age and above, for intramuscular use (FLULAVAL) | N/A | N/A | N/A |
Q2037 | Influenza virus vaccine, split virus, for use in individuals 3 years of age and above, for intramuscular use (FLUVARIN) | N/A | N/A | N/A |
Q2038 | Influenza virus vaccine, split virus, for use in individuals 3 years of age and older, for intramuscular use | Covered | Adults: Covered | Covered |
Q2039 | Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (not otherwise specified) | Covered | Adults: Covered | Covered |
Flu vaccine administration coverage by plan
Administration codes | Description | HMO/EPO, POS, | Medicaid & Healthy Michigan Plan | Medicare Advantage | |
---|---|---|---|---|---|
90460 | CPT codes for vaccine administration. (See description to select the most appropriate code) | Covered1 | Covered1 | Not covered1 See G codes | |
1 Office copay usually does not apply if vaccine administration is the only service rendered. | |||||
G0008 | HCPCS code for seasonal flu vaccine administration for Medicare patients | Not covered2 | Not covered2 | Covered | |
2 Office copay usually does not apply if vaccine administration is the only service rendered. |
Seasonal flu vaccine coverage by location
Location | HMO or EPO | POS Preferred benefit for in-network providers Alternate benefit for out-of-network providers | PPO In-network benefit for in-network providers Out-of-network benefit for out-of-network providers | Medicaid & Healthy Michigan Plan | Medicare Advantage | |
---|---|---|---|---|---|---|
Physician office | Covered at in-network providers | Covered | Covered | Covered VFC restrictions apply | Covered | |
Community clinics | Covered at in-network providers | Covered | Covered | Covered VFC restrictions apply | Covered | |
In-network providers must bill us directly. Member cannot file a claim form for reimbursement. | ||||||
Home health care services | Covered if the health care organization contracts with us and bills us directly. The cost for administration is included in the cost of the nursing visit. | |||||
Health departments | Covered at in-network providers | Covered | Covered | Covered No member reimbursement; provider must bill VFC restrictions apply | Covered | |
In-network providers must bill us directly. Member cannot file a claim form for reimbursement. | ||||||
Pharmacies that participate in the Express Scripts network | Covered3 | Covered3 | Covered3 | Covered for members age 19 and over | Covered | |
3 Commercial member must have prescription coverage. Pharmacy will bill us directly. | ||||||
Urgent care centers | Covered at in-network-providers | Covered | Covered | Covered VFC restrictions apply | Covered | |
If the center contracts with Priority Health, it must bill us directly. Member cannot file a claim form for reimbursement. | ||||||
Work site flu clinic | Covered | Covered | Covered | Not applicable | Not applicable | |
Covered if the provider contracts with Priority Health and bills us directly; member cannot file for reimbursement. |