Reminder: Submit flu shots, other vaccines as medical claims, not pharmacy claims, for non-Medicare members

Flu season will be here soon so we want to make sure pharmacies know how to submit flu shot claims. Claims for flu shots and other vaccines for Blue Cross Blue Shield of Michigan non-Medicare members should be submitted as medical (professional) claims.

Keep in mind that only pharmacies that are part of Blue Cross Blue Shield of Michigan’s Vaccine Affiliation Program can submit claims for vaccines administered to Blue Cross members.

We recently sent you an amendment to the Restated and Amended Preferred Rx Agreement that lays the groundwork to bill vaccines through the pharmacy claim system. We will notify you if we begin to allow this billing process. Claims for flu shots submitted as a pharmacy service through the pharmacy claim system will not be paid at this time.

Which members are covered?
Before giving a flu shot, be sure the member has immunization coverage. You can check coverage on web-DENIS or by calling our Provider Automated Response System, or PARS, at 1-800-344-8525. Be prepared to provide your medical PIN.

Blue Cross Blue Shield of Michigan Provider Inquiry (physicians and other professional providers of care)

You can use the following procedure codes when checking for coverage.

How to submit claims
Be sure to submit claims for flu shots and other vaccines administered to Blue Cross Blue Shield of Michigan non-Medicare members as medical (professional) claims through the medical claim system used by your pharmacy. You can work with your claim clearinghouse vendor or IT department if you are unsure of how to bill medical claims in your system. Claims for flu shots submitted as a pharmacy service through the pharmacy claim system will not be paid.

Administering multiple injections on same day
Blue Cross only allows for payment of one initial immunization administration on the same date of service. In order to be reimbursed for multiple immunization injections on the same date of service, you’ll need to report one of the 904XX add-on codes. These include 90461, 90472 and 90474.

For members with Blue Care Network commercial coverage
Continue to follow the BCN billing process for vaccines.

For Medicare Advantage members
Continue to follow the Medicare Advantage billing process for vaccines.

For Federal Employee Program^® members
Continue to follow FEP guidelines for vaccines.

None of the information included in this article is intended to be legal advice and, as such, it remains the provider’s responsibility to ensure that all coding and documentation are done in accordance with applicable state and federal laws and regulations.