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Flu Season is Here

November 14, 2019

Flu season is here, and we want to help you provide your patients, our members, the best possible care.

CDC Recommendations

The Centers for Disease Control and Prevention (CDC) recommends yearly flu shots for all patients 6 months and older without vaccine contraindication. Providers may administer any U.S. Food and Drug Administration (FDA) approved, age-appropriate flu shot. Remember, it's vital to review a current flu vaccine product table for the most recent updates on available products and their approved age ranges.

What's different this flu season?

  • All standard adult and pediatric dose flu vaccines will be quadrivalent; no trivalent regular dose flu shots are available this season.
  • Two flu strains in the 2019-2020 trivalent and quadrivalent flu vaccines have replaced two strains previously contained in 2018-2019 flu season vaccines.
  • Afluria Quadrivalent® is now licensed for children 6 months of age and older.
  • Baloxavir (Xofluza) is a new single-dose antiviral drug approved by the FDA for people 12 years and older who have had flu symptoms for less than 48 hours. Baloxavir (Xofluza) is not indicated for the prophylaxis of influenza. Baloxavir (Xofluza) is not a substitute for early vaccination with the annual seasonal flu vaccine.

Reminders this flu season:

  • Trivalent high dose or adjuvant containing flu vaccines for the elderly (65 and older) are made specifically to create a better or stronger immune response.
  • Oseltamivir (Tamiflu®) is used for the treatment of influenza for patients 2 weeks or older who have had flu symptoms for less than 48 hours, as well as the prophylaxis of influenza in patients 1 year and older.
    • Oseltamivir (Tamiflu) is also available as a generic medication, which may have a lower cost to the member compared to a branded medication.
  • Neither Baloxavir (Xofluza) nor Oseltamivir (Tamiflu) is a substitute for early vaccination with the annual seasonal flu vaccine.

Coding Reminders

  • Please file your claims with correct coding*.
  • The American Academy of Pediatrics (AAP) coding chart Learn more about third-party links recommends which billing code to use based on the vaccine administered. (This chart is not a comprehensive list.)
  • Code descriptions are specific to the vaccine product.
  • Code descriptions may include:
    • Dosage amounts
    • Trivalent vs. quadrivalent formulations
    • Distinctive features (i.e. preservative-free, split virus, recombinant DNA, cell cultures or adjuvanted).

*Note: Correct coding requires services to be reported with the most specific code available that appropriately describes the service.

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The above material is for informational purposes only and is not a substitute for the independent medical judgment of a physician or other health care provider. Physicians and other health care providers are encouraged to use their own medical judgment based upon all available information and the condition of the patient in determining the appropriate course of treatment. References to third party sources or organizations are not a representation, warranty or endorsement of such organizations. Any questions regarding those organizations should be addressed to them directly. The fact that a service or treatment is described in this material is not a guarantee that the service or treatment is a covered benefit and members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions. Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider.