Provider Administrative Policy
Our provider administrative policies contain information regarding claims submission, reimbursement, and other information in order to achieve an efficient relationship with our providers. These policies are not an authorization or explanation of benefits. Blue Cross of Idaho retains the right to add to, delete from and otherwise modify this policy in accordance with our provider contracts
If the vaccine is part of the Universal Vaccine Program, submit the appropriate CPT code with modifier SL, and a charge of $.00 for each state supplied vaccine administered.
Per CPT, Blue Cross of Idaho will only allow one "Immunization administration (includes single/first/initial immunization administration procedure at a single patient encounter). If billing for more than one immunization administration coe, use the appropriate "each additional" code for the second and subsequent administration charge(s).
Exmaple: 90471, or 90473 for first vaccine administered
Example: 90472, or 90474 for each additional vaccine administered.
|90460||Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified healthcare professional; first or only component of each vaccine/toxoid component.|
|90461||Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified healthcare professional; each additional vaccine/toxoid component (list separately in addition to code for primary procedure).|
|90471||Immunization administration (includes percutaneous, intradermal, subcutaneous, intramuscular injections); one vaccine (single or combination vaccine/toxoid), one unit.|
|90472||Each additional vaccine (single or combination vaccine/toxoids) (list separately in addition to code for primary procedure.) One or more units, depending on how many vaccines you give.|
|90473||Immunization administration by intranasal or oral route; one vaccine (single or combination vaccine/toxoids) (Do not report 90473 in conjunction with 90471)|
|90474||Each additional vaccine (single or combination vaccine/toxoids) (list separately in addition to code for primary procedure) (Use 90474 in conjunction with 90471 or 90473).|
|90649||HPV vaccine for males age 11-26 has been recommended by the CDC as a routine immunization in Dec 2011. Blue Cross of Idaho Chief Medical Officer has approved for coverage effective 01/01/2012 date of service. State supplied since 07/01/2011.|
|G0008||Administration of influenza virus vaccine when there is no physician fee schedule service on the sam day.|
|G0009||Administration of pneumococcal vaccine.|
|G0010||Administration of hepatitis B vaccine.|
|G9141||Influenza A (H1N1) immunization administration (includes the physician counseling the patient/family)|
|G9142||Influenza A (H1N1) vaccine, any route of administration|
Follow the standard instructions outlined above for BlueCard claims.
|June 2012||Revised||Code 90649 noted state supplied since 07/01/11|
|March 2012||Revised||Noted 90470 Deleted code 01/01/12/ added 90949|
|April 2011||Revised||New codes added and deleted. Clinical Editing clarification.|
|January 2011||Revised||New codes added|
|January 2010||Revised||Codes added, H1N1 added|
|May 2008||Revised||Oral codes added|