DSHS-CSHCN will provide the H1N1 flu vaccine free of charge to registered providers. Information about registration with DSHS to receive the H1N1 vaccine is available on the agency’s website at http://www.dshs.state.tx.us/txflu/flu-vaccineprovider.shtm.
The CSHCN Services Program reimburses for the administration of the intranasal or injected H1N1 vaccine. The CSHCN Services Program will reimburse the administration fee for up to two doses per client, any provider, when the doses are given on different dates following the Advisory Committee on Immunization Practices (ACIP) guidelines. (See www.cdc.gov/flu/professionals).
In order to be reimbursed for the administration of the H1N1 flu vaccine, providers must submit a claim for the administration of the vaccine in one of the following ways:
· To submit vaccine administration procedure codes 90465, 90466, 90471, or 90472, providers must include on the claim the H1N1 pandemic flu vaccine procedure code 90663, which will process as informational only.
· To submit vaccine administration procedure code 90470, which is specific to the administration of the H1N1 vaccine, providers do not need to include the procedure code for the vaccine.
Note: Claims will be processed faster when submitted with procedure code 90663 along with the appropriate administration code. Because of system constraints, claims submitted for procedure code 90470 may initially be denied with EOB 1086 on a Remittance & Status (R&S) Report and will be reprocessed in the following week and payments will be adjusted accordingly. No action on the part of the provider is necessary.
Providers must use only one method per administration of the vaccine. Both methods will reimburse the same amount to providers for administering the H1N1 vaccine.
For more information, call the TMHP-CSHCN Contact Center at 1-800-568-2413.