Effective for dates of service October 1, 2014 and forward, the Department of Social Services (DSS) will allow reimbursement for procedure code 90688 (Influenza virus vaccine, quadrivalent, split virus, when administered to individuals 3 years of age and older, for intramuscular use) under the physician office and outpatient fee schedule.
Since procedure code 90688 is currently not supplied through the Department of Public Health’s (DPH) Connecticut Vaccine Program (CVP), providers should use the appropriate vaccine and procedure code that is available through the CVP for HUSKY Health members 18 years of age and younger. Please refer to the Immunization Home Page administered by the CT DPH for more information regarding immunizations and vaccines supplied through the CVP. http://www.ct.gov/dph/cwp/view.asp?a=3136&q=511138.
In the future, if procedure code 90688 is added under the CVP, DSS will make the necessary updates to reimburse accordingly. As a reminder, DSS does not reimburse for immunization administration for clients 19 years of age or older.
This change applies to services reimbursed under HUSKY Health (HUSKY A, B, C, and D).
Accessing the Fee Schedules
Fee schedules can be accessed and downloaded by going to the Connecticut Medical Assistance Program Web site: www.ctdssmap.com. From this Web page, go to “Provider”, then to “Provider Fee Schedule Download.” Click on the “I accept” button and proceed to click on the “Physician Office and Outpt Services” fee schedule. To access the CSV file, press the control key while clicking the CSV link, then select “Open.”
For questions about billing or if further assistance is needed to access the fee schedule on the Connecticut Medical Assistance Program Web site, please contact the HP Provider Assistance Center, Monday through Friday from 8:00 a.m. to 5:00 p.m. at 1-800-842-8440.
Addition of Influenza Vaccine (CPT 90688) to the Physician Office and Outpatient Fee Schedule (full text)
Flu virus image from CDC.gov