Aetna's H1N1 Flu vaccine coverage
28 August 2009
Aetna will cover H1N1 flu vaccine administration for members whose benefit plan covers preventive services. They will pay currently recognized providers under their benefit plans for the administration of H1N1 vaccine using these age appropriate CPT codes: 90465 - 90468 or 90471 - 90474 or HCPCS code G9141 .
Based on CDC recommendations, they will pay for the administration of one or two doses of H1N1 flu vaccine. While they will pay the vaccine administration code whether or not a vaccine code is submitted, they will not pay for the H1N1 vaccine itself as it is being supplied by the federal government at no charge. The government is also providing needles, syringes, alcohol swabs, and sharps containers. They expect CPT code 90663 (Influenza virus vaccine, pandemic formulation) or HCPCS code G9142 will be the codes that are reported for H1N1 vaccine. If 90663 or G9142 is submitted, their systems are set to deny payment of 90663 or G9142.
Aetna will pay for the seasonal flu shot and its administration on the same or different dates of service as the H1N1 vaccine, based on CDC recommendations.
Become an H1N1 vaccinator
Physicians are reminded to register with your state's Department of Health to become a vaccinator. This is required in order to receive and administer the H1N1 vaccine to patients.
It is anticipated that the vaccine will be available in a combination of settings including public health organized vaccination clinics, and in private sector settings such as physician offices, retail settings, pharmacies, workplaces, and through community vaccinators. Please contact your local health department for details.
Where to go for additional information
In preparation for the anticipated second wave of H1N1 influenza, please review your business continuity plans and office policies, including phone triage and after-hours availability. The following resources are available to assist in your response planning: