IHCP will reimburse for FluMist for the 2018-2019 flu season

On August 24, 2018, the Centers for Disease Control and Prevention (CDC) released influenza vaccine recommendations for the 2018-2019 flu season, based on determinations made by the Advisory Committee on Immunization Practices (ACIP). Per the CDC:

"Following two seasons (2016-17 and 2017-18) during which ACIP recommended that LAIV4 not be used, for the 2018-19 season, vaccination providers may choose to administer any licensed, age-appropriate influenza vaccine (IIV, RIV4, or LAIV4). LAIV4 is an option for those for whom it is appropriate."

The CDC recommendations can be found on the CDC website at cdc.gov.

The Indiana Health Coverage Programs (IHCP) did not reimburse for live attenuated influenza vaccine (LAIV) in the 2016-2017 and 2017-2018 flu seasons (announced in BR201642 and BR201740). However, as a result of the updated CDC recommendation, the IHCP will reimburse for this vaccine in the 2018-2019 flu season. This reimbursement policy change applies to all IHCP programs, subject to limitations established for certain benefit packages. The change applies to vaccines billed as a medical service on CMS-1500 claims, as well as vaccines billed as a pharmacy service in the point-of-sale system.

The proper Current Procedural Terminology (CPT®1) code to use when billing LAIV4 (brand name FluMist) is 90672 - Influenza virus vaccine, quadrivalent, live (LAIV4), for intranasal use. The code must be billed with the National Drug Code (NDC) of the product administered. The NDCs for the single individual sprayer for the 2018-2019 flu season are 66019-0305-01 and 66019-0305-10.

This reimbursement change will be reflected in the next regular update to the Professional Fee Schedule at indianamedicaid.com. Reimbursement and billing guidance applies to services delivered under the fee-for-service (FFS) delivery system for dates of service (DOS) on or after October 1, 2018. Individual managed care entities (MCEs) establish and publish reimbursement and billing criteria within the managed care delivery system. Questions about managed care billing should be directed to the MCE with which the member is enrolled.

1 CPT copyright 2018 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.