Flu vaccines are covered under a member’s medical benefits unless they are a Mercy MedicareADVANTAGE member and then flu vaccines are covered under their Medicare Part B benefits.

We encourage our members to receive their seasonal flu vaccine from a participating provider.

Mercy MedicareADVANTAGE members and Missouri Consolidated Health Care Plan members can go in or out of the Mercy Health Plans provider network for their flu vaccines and we will pay up to the allowable amount based on their coverage.

We offer other options:

Mercy Health Plans members may visit one of the participating Flu Vaccine Clinics near them (below).

Or Mercy Health Plans members may pay for flu vaccination out of pocket at a non-participating clinic and submit this form for reimbursement up to $25.

Participating providers may submit a claim for the vaccine and administration fee.

Non participating providers may use this form.

Mercy Health Plans will cover the Influenza A (H1N1) vaccine administration cost using the code G9141. Since it is anticipated there will be no cost to provider for the Influenza A (H1N1) vaccines, there will be no reimbursement. However, we ask that providers submit a claim for the Influenza A (H1N1) vaccine using the code G9142 for tracking purposes.

If a member pays for the H1N1 vaccination out of pocket at a non-participating clinic, they can submit this form for reimbursement up to $20.

Mercy Health Plans covers FluMist for healthy non-pregnant members ages 2-49 years. Mercy Health Plans coverage for this vaccine is consistent with the current CDC and FDA guidelines.

Remember that there needs to be at least four weeks between the administration of the live attenuated influenza vaccine (LAIV) and the Influenza A (H1N1) vaccine.

Mercy Health Plans follows the 2009 Advisory Committee on Immunization Practices (ACIP) guidelines when determining benefits and reimbursement for the pneumococcal vaccine.

Mercy Health Plans follows the 2009 Advisory Committee on Immunization Practices (ACIP) guidelines. Coverage may vary by plan, for additional information, please contact your provider relations representative for details.

Seasonal flu vaccine codes
90655	Influenza virus vaccine split preservative free 6-35 month
90656	Influenza vaccine no preservative age 3 years+
90657	Influenza vaccine age 6-35 months
90658	Influenza vaccine age 3 years+
90660	Influenza live attenuated vaccine given through nose
Administration codes
90465-90474	Influenza administration codes
G0008 and G0009	Pneumococcal vaccine administration codes
Influenza A (H1N1) vaccine codes
Medicare
G9142	Influenza A (H1N1) vaccine, any route of administration
G9141	Influenza A (H1N1) immunization administration (includes the physician counseling the patient/family)
Non-Medicare
90663	Influenza virus vaccine, pandemic formulation
90470	H1N1 immunization administration (intramuscular, intranasal)
Pneumococcal vaccine codes
90669	Pneumococcal conjugate vaccine < 5 years
90732	Pneumococcal polysaccharide vaccine age 2 years+

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