H1N1 Information for Providers
With the impending delivery of the new vaccine for the novel A H1N1 flu virus, Blue Cross and Blue Shield of Oklahoma (BCBSOK) wants to make our network physicians aware of our policy concerning coverage of charges for administering the vaccine for BCBSOK members.
Some members’ health plan medical benefits may not cover vaccination charges. In order to ensure our members get the best treatment available, BCBSOK has implemented a policy to cover administration of the vaccine for our fully-insured group members and individual health plan members under the age of 65 without regard to whether their current plan covers vaccinations. Plan65 (Medicare supplement) members already have their vaccinations covered through their Medicare benefits.
We will cover this fee without applying it to members' deductible or coinsurance. We also will work proactively with all the employers we work with who have self-funded employer health benefit plans to recommend they adjust their benefit coverage to also cover administration of the vaccine.
In order to benefit from this special coverage, a member must receive the vaccination from a BCBSOK network provider. When using a provider that is not in the BCBSOK network, normal benefit coverage will apply.
This coverage will be available for the five priority populations the Centers for Disease Control and Prevention (CDC) recommends receive the vaccine first: pregnant women, people who live with or care for children younger than 6 months of age, healthcare and emergency medical services personnel, persons between the ages of 6 months through 24 years, and people ages 25 through 64 years who have chronic health disorders or compromised immune systems.
Please use the following codes for the H1N1 vaccine:
- G9142 — Influenza A (H1N1) vaccine, any route of administration
- G9141 — Influenza A (H1N1) immunization administration (includes the physician counseling the patient/family)
Since the vaccine is being supplied by the federal government at no charge, BCBSOK will allow $.01 for CPT code G9142 effective 9/15/2009. A claim for the vaccine (G9142) is required in order to process the claim for administration (G9141).