Influenza vaccine coverage

• 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 09/01/2023 

Child = 0-18 years Adult = 19 + years

 

Codes	Description	HMO/EPO, POS, PPO	Medicaid & Healthy Michigan Plan	Medicare Advantage plans
90630	Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, for intradermal use BN: No active NDC for this code	N/A	N/A	N/A
90653	Influenza virus vaccine, inactivated (IIV), subunit, adjuvanted, for intramuscular use No active NDC for this code	N/A	N/A	N/A
90654	Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, for intradermal use BN: No active NDC for this code	N/A	N/A	N/A
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 BN: No active NDC for this code	N/A	N/A	N/A
90657	Influenza virus vaccine, trivalent (IIV3), split virus, 0.25mL dosage, for intramuscular use BN: No active NDC for this code	N/A	N/A	N/A
90658	Influenza virus vaccine, trivalent (IIV3), split virus, 0.5mL dosage, for intramuscular use BN: No active NDC for this code	N/A	N/A	N/A
90660	Influenza virus vaccine, trivalent (LAIV3), live, for intranasal use BN: No active NDC for this code	N/A	N/A	N/A
90661	Influenza virus vaccine (ccIIV3), derived from cell cultures, subunit, preservative and antibiotic free, 0.5mL dosage, for intramuscular use BN: No active NDC for this code	N/A	N/A	N/A
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 Ages 2-49 only BN: FLUMIST QUADRIVALENT	Covered	Adults: Covered Children: VFC	Covered
90673	Influenza virus vaccine, trivalent (RIV3), derived from recombinant DNA (RIV3), hemagglutinin (HA) protein only, preservative and antibiotic free, for intramuscular use BN: No active NDC for this code	N/A	N/A	N/A
90674	Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage, for intramuscular use Ages 6 months and older BN: FLUCELVAX QUADRIVALENT	Covered	Adults: Covered Children: VFC	Covered
90682	Influenza virus vaccine, quadrivalent (RIV4), derived from recombinant DNA, hemagglutinin (HA) protein only, preservative and antibiotic free, for intramuscular use Ages 18 years and older BN: FLUBLOK QUADRIVALENT	Covered	Covered	Covered
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: FLUZONE QUADRIVALENT (ages 6 months and older) FLUARIX QUADRIVALENT (ages 6 months and older) AFLURIA QUADRIVALENT (ages 3 years and older) FLULAVAL QUADRIVALENT (ages 6 months and older)	Covered	Adults: Covered Children: VFC	Covered
90687	Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.25mL dosage, for intramuscular use Ages 6 months and older BN: AFLURIA QUADRIVALENT FLUZONE QUADRIVALENT	Covered	Adults: Not Covered, Children: VFC	Covered
90688	Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, 0.5mL dosage, for intramuscular use BN: FLUZONE QUADRIVALENT (6 months and older) AFLURIA QUADRIALENT (3 years and older)	Covered	Adults: Covered Children: VFC	Covered
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 Ages 65 and older BN: FLAUD QUADDRIVALENT	Covered	Covered	Covered
90756	Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, antibiotic free, 0.5mL dosage, for intramuscular use Ages 6 months and older BN: FLUCELVAX QUADRIVALENT	Covered	Adults: Covered Children: VFC	Covered
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 No active NDC for this code	N/A	N/A	N/A
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 (FLUZONE) BN: No active NDC for this code	N/A	N/A	N/A
Q2039	Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (not otherwise specified) BN: No active NDC for this code	N/A	N/A	N/A

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.
Pharmacies that don't participate	Member can pay and file for reimbursement.
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.