News: New Reimbursement Policy for FluMist (Update 10-31-10)

Update October 31, 2010: TNAAP is Working for You!

We are pleased to announce that our Pediatric Council has been successful in convincing BCBS of Tennessee to change their reimbursement policy for their commercial line of business regarding FluMist.

BCBS has advised us that they will begin processing claims at AWP, effective November 1, 2010. It does not appear that there will be any retroactive adjustments for FluMist prior to November 1, 2010, however, practices are encouraged to discuss this with their BCBS provider representatives.

September 30, 2010: TNAAP is Working for You!

We are pleased to announce that our Pediatric Council has been successful in convincing CoverKids and BCBS of Tennessee to change their reimbursement policy for FluMist.

As you are probably aware, most BlueCross BlueShield plans pay below acquisition cost for FluMist (CPT 90660).  FluMist is listed on the CDC’s private sector price list for $19.70 per dose.  Practices have historically had the unenviable decision of vaccinating only with injectible vaccine (leading to lower vaccine uptake); collecting cash and a signed ABN for a vaccine that, for all other insurances, is a covered service; or taking a huge financial hit every year during flu season.

Under CoverKids the situation has been even more untenable as practices are not allowed to balance bill for preventive services on CoverKids.
TNAAP’s Pediatric Council has pointed out this incongruity to BCBS leadership, and we are pleased to report that BCBS is changing its payment policy for CoverKids.  BCBS announced it will now pay AWP for FluMist, for CoverKids, plus the administration fee (90467 and 90468 for children younger than 8 years with physician counseling and 90473 and 90474 for children over 8 years.)

BCBS has advised us that they will begin processing claims at the new rate effective October 1, 2010.  In addition, a “look back” of FluMist claims will occur for the time period from 10/1/09 through 9/30/10. A specific time line for the “look back” has not been provided but it is our hope that these claims will be adjusted sometime in October.