New Flu Vaccine Code Added to Pennsylvania’s Medicaid Fee Schedule

vaccine-articlePennsylvania’s Medicaid program – known as Medical Assistance (MA) – is adding flu vaccine code 90756 to the MA Fee Schedule.

The code, which is effective for dates of service on or after March 5, 2018, is for the administration of the Flucelvax Quadrivalent® vaccine that contains a preservative as supplied in a multi-dose vial. It is approved for MA beneficiaries four years of age and older.

Pennsylvania’s Department of Human Services (DHS) announced the new code via this MA Bulletin issued on March 5, 2018. DHS made the change to remain consistent with the Centers for Medicare and Medicaid Services, which has made flu vaccine code 90756 available since Jan. 1, 2018.

Reimbursement for Flu Vaccine Code 90756

The MA fee for the administration of each vaccine is $10.00 per administration. DHS reminds clinicians participating in a Medicaid Managed Care Organization (MCO) network that they must abide by payment arrangements as stated in their individual MCO contract.

Important note: For administration of the multi-dose Flucelvax Quadrivalent® vaccine during the period of July 12, 2017 through March 4, 2018, you must bill using code 90749 (unlisted vaccine/toxoid).

Additional Resources

For more details on the new code, access DHS’ MA Bulletin here. DHS also provides an online MA Fee Schedule here.

Pennsylvania Medical Society (PAMED) members with questions can also contact our Knowledge Center at 855-PAMED4U (855-726-3348) or KnowledgeCenter@pamedsoc.org.  

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