Influenza vaccine coverage

Page last updated on: 5/29/25
  • 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.

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    Flu vaccine coverage by plan, effective 09/01/2024 

    Child = 0-18 years Adult = 19 + years

     

    Codes

    Description

    HMO/EPO, POS,
    PPO

    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
    BN: FLUAD

    Covered

    Adults: Covered
    Children: VFC

    Covered

    90655

    Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, 0.25mL dosage, for intramuscular use
    BN: No active NDC for this code 

    N/A

    N/A

    N/A

    90656

    Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, for 0.5mL dosage, for intramuscular use
    Ages: 6 months and older
    BN: AFLURIA, FLUZONE, FLUVARIX, FLULAVAL

    Covered

    Adults: Covered
    Children: VFC

    Covered

    90657

    Influenza virus vaccine, trivalent (IIV3), split virus, 0.25mL dosage, for intramuscular use
    Ages: 6 months and older
    BN: AFLURIA, FLUZONE

    Covered

    Adults: Covered
    Children: VFC

    Covered

    90658

    Influenza virus vaccine, trivalent (IIV3), split virus, 0.5mL dosage, for intramuscular use
    Ages: 6 months and older
    BN: AFLURIA, FLUZONE

    Covered

    Adults: Covered
    Children: VFC

    Covered

    90660

    Influenza virus vaccine, trivalent (LAIV3), live, for intranasal use
    Ages: 2-49 years
    BN:FLUMIST

    Covered

    Adults: Covered
    Children: VFC

    Covered

    90661

    Influenza virus vaccine (ccIIV3), derived from cell cultures, subunit, preservative and antibiotic free, 0.5mL dosage, for intramuscular use
    Ages: 6 months and older
    BN: FLUCELVAX

    Covered

    Adults: Covered
    Children: VFC

    Covered

    90662

    Influenza virus vaccine (IIV), split virus, preservative free, enhanced immunogenicity via increased antigen content, for intramuscular use
    Ages 65 years & older only
    BN: FLUZONE HIGH DOSE

    Covered

    Covered

    Covered

    90664

    Influenza virus vaccine, live (LAIV) pandemic formulation, for intranasal use
    BN: No active NDC for this code

    N/A

    N/A

    N/A

    90666

    Influenza virus vaccine (IIV), pandemic formulation, split virus, preservative free, for intramuscular use
    BN: No active NDC for this code

    N/A

    N/A

    N/A

    90667

    Influenza virus vaccine (IIV), pandemic formulation, split virus, adjuvanted, for intramuscular use
    BN: No active NDC for this code

    N/A

    N/A

    N/A

    90668

    Influenza virus vaccine (IIV), pandemic formulation, split virus, for intramuscular use
    BN: No active NDC for this code

    N/A

    N/A

    N/A

    90672

    Influenza virus vaccine, quadrivalent, live (LAIV4), for intranasal use
    BN: No active NCD for this code

    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
    Ages: 18 years and older
    BN: FLUBLOK

    Covered

    Adults: Covered
    Children: VFC

    Covered

    90674

    Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage, for intramuscular use
    BN: No active NDC for this code

    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
    BN: No active NDC for this code

    N/A

    N/A

    N/A

    90685

    Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, 0.25 mL dosage, for intramuscular use
    No active NDC for this code

    N/A

    N/A

    N/A

    90686

    Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, 0.5mL dosage, for intramuscular use
    BN: No active NDC for this code

    N/A

    N/A

    N/A

    90687

    Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.25mL dosage, for intramuscular use
    BN: No active NDC for this code

    N/A

    N/A

    N/A

    90688

    Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, 0.5mL dosage, for intramuscular use
    BN: No active NDC for this code

    N/A

    N/A

    N/A

    90689

    Influenza virus vaccine quadrivalent (IIV4), inactivated, adjuvanted, preservative free, 0.25 mL dosage, for intramuscular use
    BN: No active NDC for this code 

    N/A

    N/A

    N/A

    90694

    Influenza virus vaccine, quadrivalent (allV4), inactivated, adjuvanted, preservative free, 0.5 mL dosage, for intramuscular use
    BN: No active NDC for this code

    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
    BN: FLUCELVAX

    Covered

    Adults: Covered
    Children: VFC

    Covered

    90756

    Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, antibiotic free, 0.5mL dosage, for intramuscular use
    BN: No active NDC for this code

    N/A

    N/A

    N/A

    Q2034

    Influenza virus vaccine, split virus, for intramuscular use (AGRIFLU)
    BN: No active NDC for this code

    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
    BN: AFLURIA

    Covered

    Adults: Covered
    Children: VFC

    Covered

    Q2036

    Influenza virus vaccine, split virus, for use in individuals 3 years of age and above, for intramuscular use (FLULAVAL)
    BN: No active NDC for this code

    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)
    BN: No active NDC  for this code

    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
    BN: FLUZONE

    Covered

    Adults: Covered
    Children: VFC

    Covered

    Q2039

    Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (not otherwise specified)
    BN: FLUCELVAX

    Covered

    Adults: Covered
    Children: VFC

    Covered

    Flu vaccine administration coverage by plan

    Administration codes

    Description

    HMO/EPO, POS,
    PPO

    Medicaid & Healthy Michigan Plan

    Medicare Advantage

    90460
    90461
    90471
    90472
    90473
    90474

    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.
    Commercial plans: Out-of-network providers may bill us or member can pay and file for reimbursement. Coverage is subject to out-of-network benefits.
    Priority Health Medicare Advantage plan members: Cost is $0 in any out-of-network setting. Non-contracted providers should bill Priority Health. Coverage is subject to out-of-network benefits.

    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.
    Commercial plans: Out-of-network providers may bill us or member can pay and file for reimbursement. Coverage is subject to out-of-network benefits.
    Priority Health Medicare Advantage members: Cost is $0 in any out-of-network setting. Non-contracted providers should bill Priority Health.

    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.
    Priority Health Medicare Advantage members: Covered under medical benefit. Pharmacy will bill us.

    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.
    Commercial plans: Out-of-network providers may bill us or member can pay and file for reimbursement. Subject to out-of-network benefits.
    Priority Health Medicare Advantage members:  Cost is $0 in any out-of-network setting. Non-contracted providers should bill Priority Health.
    Urgent care copay will not apply if only service is flu vaccine.

    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.
    Not covered if the employer has a discount arrangement with the provider (even if contracted) and the provider will be paid directly by the employer. Member cannot file a claim form for reimbursement.