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Home Influenza Vaccine Rates for 2016-2017

Influenza Vaccine Rates for 2016-2017

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

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: $20.22
(administrative fee 
included)

Regular Flu Vaccine:
Vaccine Code: CPT code 90658
on a CMS 1500 claim form.
Payment: $16.50
(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)