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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)
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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)
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