News
AMBETTER VACCINE, IMMUNIZATIONS, AND IMPLANTABLE BIRTH CONTROL REIMBURSEMENT CHANGE
Fecha: 24/08/17
Thank you for your participation in the Ambetter from Peach State Health Plan network. As our health plan grows we continually evaluate and evolve our reimbursement methodologies to better support our providers.
We are writing to inform you that after careful consideration of feedback from our provider partners, we have re-evaluated our reimbursement rates for vaccines, immunizations, and implantable birth control. These preventive services are important to the health of our members, and we want to ensure that our reimbursement rates value them.
This change will take effect on September 1, 2017. Please see below the complete schedule of the vaccines, immunizations, and implantable birth control devices impacted by this change, along with their corresponding rates. Please don’t hesitate to reach out to Provider Solutions at 1-866-874-0633 or your Provider Network Specialist with any questions you may have.
| Code | Description | Rate |
|---|---|---|
| 90632 | Hepatitis A Vaccine, Adult Dosage, For Intramuscular Use | 68.69 |
| 90636 | Hepatitis A And Hepatitis B (Hepa-Hepb), Adult Dosage, For Intramuscular Use | 102.58 |
| 90653 | Influenza Virus Vaccine, Inactivated, Subunit, Adjuvanted For Im Us | 35.42 |
| 90654 | Influenza Virus Vaccine, Split Virus, Preservative Free, For Intradermal Use | 17.92 |
| 90662 | Influenza Virus Vaccine, Split Virus, Preservative Free, Enhanced Immunogenicity Via Increased Antigen Content, For Intramuscular Use | 40.47 |
| 90673 | Influenza Virus Vaccine, Trivalent, Derived From Recombinant Dna (Riv3), Hemagglutnin (Ha) Protein Only, Preservative And Antibiotic Free, For Intramuscular Use | 38.48 |
| 90703 | Tetanus Toxoid Adsorbed, For Intramuscular Use | 43.44 |
| 90704 | Mumps Virus Vaccine, Live, For Subcutaneous Use | 23.89 |
| 90705 | Measles Virus Vaccine, Live, For Subcutaneous Use | 18.43 |
| 90706 | Rubella Virus Vaccine, Live, For Subcutaneous Use | 20.55 |
| 90736 | Zoster (Shingles) Vaccine, Live, For Subcutaneous Injection | 212.67 |
| Q2035 | Influenza Virus Vaccine, Split Virus, When Administered To Individuals 3 Years Of Age And Older, For Intramuscular Use (Afluria) | 15.43 |
| Q2036 | Influenza Virus Vaccine, Split Virus, When Administered To Individuals 3 Years Of Age And Older, For Intramuscular Use (Flulaval) | 8.13 |
| Q2037 | Influenza Virus Vaccine, Split Virus, When Administered To Individuals 3 Years Of Age And Older, For Intramuscular Use (Fluvirin) | 15.43 |
| Q2038 | Influenza Virus Vaccine, Split Virus, When Administered To Individuals 3 Years Of Age And Older, For Intramuscular Use (Fluzone) | 11.41 |
| 90620 | Meningococcal Recombinant Protein And Outer Membrane Vesicle Vaccine, Serogroup B, 2 Dose Schedule, For Intramuscular | 173.48 |
| 90621 | Meningococcal Recombinant Lipoprotein Vaccine, Serogroup B, 3 Dose Schedule, For Intramuscular Use | 132.33 |
| 90630 | Influenza Virus Vaccine, Quadrivalent (Iiv4), Split Virus, Preservative Free, For Intradermal Use | 19.27 |
| 90633 | Hepatitis A Vaccine, Pediatric/Adolescent Dosage-2 Dose Schedule, For Intramuscular Use | 32.42 |
| 90644 | Meningococcal Conjugate Vaccine, Serogroups C & Y And Hemophilus Influenza B Vaccine (Mency-Hib) | 26.42 |
| 90647 | Haemophilus Influenza B Vaccine (Hib), Prp-Omp Conjugate (3 Dose Schedule), For Intramuscular Use | 27.14 |
| 90648 | Haemophilus Influenza B Vaccine (Hib), Prp-T Conjugate (4 Dose Schedule), For Intramuscular Use | 10.94 |
| 90656 | Influenza Virus Vaccine, Trivalent, Split Virus, Preservative Free, For Use In Individuals 3 Years Of Age And Above, For Intramuscular Use | 16.79 |
| 90657 | Influenza Virus Vaccine, Trivalent, Split Virus, For Children 6-35 Months Of Age, For Intramuscular Use | 6.02 |
| 90658 | Influenza Virus Vaccine,Trivalent, Split Virus, For Use In Individuals 3 Years Of Age And Above, For Intramuscular Use | 15.43 |
| 90670 | Pneumococcal Conjugate Vaccine, 13 Valent, For Intramuscular Use | 182.50 |
| 90672 | Influenza Virus Vaccine, Quadrivalent (Laiv), Live, Intranasal Use | 25.46 |
| 90674 | Influenza Virus Vaccine, Quadrivalent (Cciiv4), Derived From Cell Cultures, Subunit, Preservative And Antibiotic Free, 0.5 Ml Dosage, For Intramuscular Use | 21.73 |
| 90680 | Rotavirus Vaccine, Pentavalent, 3 Dose Schedule, Live, For Oral Use | 87.64 |
| 90681 | Rotavirus Vaccine, Human, Attenuated, 2 Dose Schedule, Live, For Oral Use | 118.39 |
| 90685 | Influenza Virus Vaccine, Quadrivalent, Split Virus, Preservative Free, When Administered To Children 6-35 Months Of Age, For Intramuscular Us | 24.89 |
| 90686 | Influenza Virus Vaccine, Quadrivalent, Split Virus, Preservative Free, When Administered To Individuals 3 Years Of Age And Older, For Intramuscular Use | 18.03 |
| 90687 | Influenza Virus Vaccine, Quadrivalent, Split Virus, When Administered To Children 6-35 Months Of Age, For Intramuscular Use | 8.91 |
| 90688 | Influenza Virus Vaccine, Quadrivalent, Split Virus, When Administered To Individuals 3 Years Of Age And Older, For Intramuscular Use | 17.03 |
| 90696 | Diphtheria, Tetanus Toxoids, Acellular Pertussis Vaccine And Poliovirus Vaccine, Inactivated (Dtap-Ipv), When Administered To Children 4 Years Through 6 Years Of Age, For Intramuscular Use | 52.76 |
| 90698 | Diphtheria, Tetanus Toxoids, And Acellular Pertussis Vaccine, Haemophilus Influenza Type B, And Poliovirus Vaccine, Inactivated (Dtap - Hib - Ipv), For Intramuscular Use | 96.53 |
| 90700 | Diphtheria, Tetanus Toxoids, And Acellular Pertussis Vaccine (Dtap), For Use In Individuals Younger Than Seven Years, For Intramuscular Use | 23.24 |
| 90702 | Diphtheria And Tetanus Toxoids (Dt) Adsorbed For Use In Individuals Younger Than Seven Years, For Intramuscular Use | 26.69 |
| 90707 | Measles, Mumps And Rubella Virus Vaccine (Mmr), Live, For Subcutaneous Use | 71.99 |
| 90710 | Measles, Mumps, Rubella, And Varicella Vaccine (Mmrv), Live, For Subcutaneous Use | 205.87 |
| 90713 | Poliovirus Vaccine, Inactivated, (Ipv), For Subcutaneous Or Intramuscular Use | 33.41 |
| 90714 | Tetanus And Diphtheria Toxoids (Td) Adsorbed, Preservative Free, For Use In Individuals Seven Years Or Older, For Intramuscular Use | 23.71 |
| 90715 | Tetanus, Diphtheria Toxoids And Acellular Pertussis Vaccine (Tdap), For Use In Individuals 7 Years Or Older, For Intramuscular Use | 41.29 |
| 90716 | Varicella Virus Vaccine, Live, For Subcutaneous Use | 124.24 |
| 90723 | Diphtheria, Tetanus Toxoids, Acellular Pertussis Vaccine, Hepatitis B, And Poliovirus Vaccine, Inactivated (Dtap-Hepb-Ipv), For Intramuscular Use | 77.88 |
| 90732 | Pneumococcal Polysaccharide Vaccine, 23-Valent, Adult Or Immunosuppressed Patient Dosage, For Use In Individuals 2 Years Or Older, For Subcutaneous Or Intramuscular Use | 93.65 |
| 90733 | Meningococcal Polysaccharide Vaccine (Any Group(S)), For Subcutaneous Use | 132.89 |
| 90734 | Meningococcal Conjugate Vaccine, Serogroups A, C, Y And W-135 (Tetravalent), For Intramuscular Use | 121.83 |
| 90740 | Hepatitis B Vaccine, Dialysis Or Immunosuppressed Patient Dosage (3 Dose Schedule), For Intramuscular Use | 179.19 |
| 90743 | Hepatitis B Vaccine, Adolescent (2 Dose Schedule), For Intramuscular Use | 63.68 |
| 90744 | Hepatitis B Vaccine, Pediatric/Adolescent Dosage (3 Dose Schedule), For Intramuscular Use | 24.06 |
| 90746 | Hepatitis B Vaccine, Adult Dosage, For Intramuscular Use | 58.24 |
| 90747 | Hepatitis B Vaccine, Dialysis Or Immunosuppressed Patient Dosage (4 Dose Schedule), For Intramuscular Use | 116.49 |
| 90748 | Hepatitis B And Hemophilus Influenza B Vaccine (Hepb-Hib), For Intramuscular Use | 42.42 |
| 90669 | Pneumococcal Conjugate Vaccine, Polyvalent, For Children Under Five Years, For Intramuscular Use | 90.46 |
| J7297 | Levonorgestrel-releasing intrauterine contraceptive system (Liletta), 52 mg | 675.00 |
| J7298 | Levonorgestrel-releasing intrauterine contraceptive system (Mirena), 52 mg | 927.00 |
| J7300 | Intrauterine copper contraceptive | 798.12 |
| J7301 | Levonorgestrel-releasing intrauterine contraceptive system (Skyla), 13.5 mg | 771.88 |
| J7302 | Levonorgestrel-releasing intrauterine contraceptive system, 52 mg (Code deleted effective 12/31/15) - see J7297 or J7298 | 675.00 |
| J7303 | Contraceptive supply, hormone containing vaginal ring, each | 138.47 |
| J7304 | Contraceptive supply, hormone containing patch, each | 39.72 |
| J7307 | Etonogestrel (contraceptive) implant system, including implant and supplies (Code Price is per 1 implant system) | 915.73 |
| 90649 | Human Papillomavirus vaccine, types 6, 11, 16, 18, quadrivalent (4vHPV), 3 dose schedule, for intramuscular use (Code Price is per dose = 0.5 mL) (Gardasil is only indicated in males and females from 9 through 26 years of age) | 172.85 |
| 90650 | Human Papillomavirus vaccine, types 16, 18, bivalent (2vHPV), 3 dose schedule, for intramuscular use (Code Price is per dose = 0.5 mL) (Cervarix is only indicated for females 9 through 25 years of age) | 143.06 |
| 90651 | Human Papillomavirus vaccine types 6, 11, 16, 18, 31, 33, 45, 52, 58, nonavalent (9vHPV), 3 dose schedule, for intramuscular use (Code Price is per one dose = 0.5 mL) (Gardasil 9 is only indicated for females from 9 through 26 years of age and males from 9 through 15 years of age) | 208.99 |