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Home Influenza Vaccine Rates for 2015-2016

Influenza Vaccine Rates for 2015-2016

Medi-Cal

Healthy Kids

CHDP Free Vaccine -
Vaccine available at no cost
from CA Vaccines for Children Program 
(877) 243-8832

Ages: 6 months to 18 years
Vaccine Code: CHDP code 53
billed as an electronic PM 160
claim submission.

Payment: $9.92

FluMist Nasal Spray
Covered without prior authorization.
Vaccine Code: CHDP code 71
billed as an 
electronic PM 160
claim submission.

Payment: $9.92

CHDP-Privately Purchased Vaccines:
Ages: 6 months to 35 months
Vaccine Code: CHDP code
80 –Influenza
(Inactivated) Preservative Free
billed as an electronic PM 160
claim submission
Payment: $20.63
(administrative fee included)

Ages: 36 months to 20 years
Vaccine Code: CHDP code 54
billed as an 
electronic PM 160
claim submission.

Payment: $15.17
(administrative fee 
included)

Privately Purchased Vaccines
Ages: 21 and over

Preservative Free Flu Vaccine:
Vaccine Code: CPT code 90656 on a CMS 1500
claim form.

Payment: $20.46
(administrative fee 
included)

Regular Flu Vaccine:
Vaccine Code: CPT code 90658
on a CMS 1500 claim form.
Payment: $18.57
(administrative fee included)

FluMist Nasal Spray
Covered without prior authorization.
Code: CPT code 90660
on a CMS 1500 claim form.
Payment: $24.63
(administrative fee included)

Privately Purchased Vaccines

Ages: 6 months to 35 months

Preservative Free Flu Vaccine:
Vaccine Code: 90655
on a CMS 1500 claim form 
Payment: $32.18
(administrative fee included)

Regular Flu Vaccine
Vaccine Code: 90657
on a CMS 1500 claim form.
Payment: $32.18
(administrative fee included)

Ages: 3 to 19 years

Preservative Free Flu Vaccine:
Vaccine Code: 90656
on a CMS 1500 claim form.
Payment: $32.18
(administrative fee included).

Regular Flu Vaccine:
Vaccine Code: 90658
on a CMS 1500 claim form.
Payment: $32.18
(administrative fee included)

FluMist Nasal Spray
Covered without prior authorization.
Code: CPT 90660
on a CMS 1500 claim form.
Payment: $29.70
(administrative fee included)