Policy UpdatesSimply Healthcare Plans, Inc. - Florida Healthy KidsMay 14, 2024

2024 flu and pneumonia vaccines — reimbursement

Flu and pneumonia vaccines are covered benefits for members enrolled in Florida Healthy Kids (FHK). Members have been advised to go to any participating pharmacy or PCP to get the flu shot. For the pneumococcal vaccine, they should consult with their PCP.

Participating providers will be reimbursed for the cost of the vaccine and an administration fee by billing with the administration code in addition to the below procedure codes.

Member education efforts will continue throughout the season. Thank you in advance for promoting the importance of flu prevention in your practice and to our members during their visit. We look forward to working together to achieve improved outcomes and helping minimize the flu’s impact on patients, their families, and the community this flu season.

Immunization fee schedules

Influenza vaccines

Code

Description

Units

Age

Max fee

90656

Influenza vaccine for administration into muscle, 0.5ml dosage, preservative free

1

5-18

$16.28

90658

Influenza vaccine for administration into muscle, 0.5ml dosage

1

5-18

$13.93

90672

Influenza vaccine quadrivalent, nasal administration

1

5-18

$27.79

90674

Influenza vaccine derived from cell cultures (ccIIV4) preservative/antibiotic free 0.5ml intramuscular

1

5-18

$34.17

90682

Influenza vaccine derived from DNA for injection into muscle, quadrivalent, preservative and antibiotic free

1

18 only

$73.40

90686

Influenza vaccine, intramuscular administration, 0.5ml dosage, quadrivalent, preservation free

1

5-18

$22.35

90688

Influenza vaccine intramuscular administration, 0.5ml dosage, quadrivalent MDV

1

5-18

$20.88

90756

Influenza vaccine derived from cell cultures, intramuscular, quadrivalent, antibiotic free, 0.5ml

1

5-18

$32.37

Pneumonia vaccines

Code

Description

Units

Age

Max fee

90670

Pneumococcal conjugate 13 valent, intramuscular

1

5-18

$257.99

90671

Pneumococcal conjugate Vaccine 15 valent, intramuscular (PCV15)

1

18

$253.56

90677

Pneumococcal conjugate Vaccine 20 valent, intramuscular (PCV20)

1

18

$288.66

90732

Pneumococcal polysaccharide 23 valent subcutaneous or intramuscular

1

18

$133.47

Administration codes

Code

Description

Admin fee

90460

Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; first or only co

$10

90461

Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; each additional

$10

90471

Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 vaccine

$10

90472

Immunization Administration; Each Add'l Single/Combination Vaccine/Toxoid

$10

90473

Immunization Administration, Intranasal/Oral; 1 Single/Combination Vaccine/Toxoid

$10

90474

Immunization Administration, Intranasal/Oral; Ea Add'l Single/Combination Vaccine/Toxoid

$10

Simply Healthcare Plans, Inc. is a Managed Care Plan with a Florida Medicaid contract.
Simply Healthcare Plans, Inc. is a Managed Care Plan with a Florida Healthy Kids contract.

FLSMPLY-CD-052041-24