Fall Vaccinations: Influenza Vaccine, RSV immunization and COVID-19 Vaccine

On August 26, 2024, the CDC published the respiratory vaccine codes and crosswalk tables for RSV, COVID-19, and influenza.  This article provides some background information and considerations related to the upcoming fall vaccination season for influenza, RSV and COVID-19.   Each Pediatric practice has choices related to their approach and management of these immunizations available for their patients.   The Physician Xpress team is committed to managing the revenue cycle of vaccines that lead to profitable Pediatric Practices.

Influenza Vaccine

The CDC recommends all children aged 6 months and older receive the seasonal influenza vaccine annually, ideally before the end of October. There are two main types of flu vaccines: the inactivated influenza vaccine (IIV) and the live attenuated influenza vaccine (LAIV), with specific guidelines for different age groups.   Note that both vaccine configurations are now trivalent vaccines.  Influenza vaccine is an important prevention that is available for the 2024-2025 season for all patients over 6 months in age.

Recommended Codes:

• Inactivated Influenza Vaccine (IIV)
  • Syringe (most common):  CPT Code: 90656 (Trivalent, preservative-free), CVX Code: 140 (Trivalent, preservative-free)
  • Multi-dose vial (Most common ):  CPT Code: 90657 (.25ml) or 90658 (.5ml) (Trivalent, preservative-free), CVX Code: 141 (Trivalent, preservative-free)
• Live Attenuated Influenza Vaccine (LAIV)
  • CPT Code: 90660 (Trivalent, intranasal)
  • CVX Code: 111 (LAIV, quadrivalent)

These codes as well as the most common NDC numbers aligned to these codes are within the PediatricXpress system.  

Considerations for Administering influenza vaccines:

1. Integrate influenza vaccine into Appointment Process – The medical leader for the pediatric practice should determine how the administration of influenza will be integrated into visits (i.e. during a scheduled well visit, separate appointment intended only for vaccination and/or via “flu vaccine” clinics).
2. Suggestions on Calling/Scheduling – The PediatricXpress system has the ability to send Broadcast email to all families with active emails to announce “Flu vaccine” clinics at the practice.  

RSV Immunization: 2nd season that Beyfortus is available

The RSV immunization, Beyfortus, is recommended for all babies entering their first RSV season (Babies born after 3/1/24).    The RSV monoclonal antibody product, Nirsevimab, was approved to help protect infants entering their first RSV season.   Beyfortus is an important RSV prevention that is available for the 2024-2025 season for babies.     

Recommended Codes:

• RSV Monoclonal Antibody (Nirsevimab)
  • CPT Code: 90380 (Single-dose vial, intramuscular – under 5 kg), 90381 ((Single-dose vial, intramuscular – over 5 kg)
  • CVX Code: 306 (for 90380) or 307 (for 90381)

Considerations for Administering Beyfortus

1. Integrate Beyfortus into Appointment Process – The medical leader for the pediatric practice should determine how the administering of Beyfotus will be integrated into visits (i.e. during a scheduled well visit, separate appointment intended only for vaccination).
2. Suggestions on Calling/Scheduling:  The PediatricXpress system has a specific report that lists all of the patients born after 3/1/2024 that are eligible for Beyfortus. For the patients with no scheduled well visit between the dates of October and November 30th, the practice should consider scheduling them for the vaccine prior to the end of November 2024. Due to the cost of this vaccine, the practice should verify each patient’s insurance coverage at least one week prior to their scheduled appointment. 

COVID-19 Vaccination

With updated COVID-19 vaccines designed to target newer variants, the CDC continues to recommend COVID-19 vaccinations for all children 6 months and older, including booster doses for certain age groups.  Almost all the COVID19 vaccines in 2024-2025 will either be from Pfizer (Comirnaty) or Moderna (Spikevax)

Recommended Codes:

• COVID-19 mRNA Vaccine (Pfizer)
  • 6 months to 4 years:  CPT Code: 91318
  • 5 years to 11 years:  CPT Code: 91319
  • 12 years and older:  CPT code 91320
• COVID-19 mRNA Vaccine (Moderna)
  • 6 months to 11 years:  CPT Code: 91321
  • 12 years and older:  CPT code 91322

Considerations for Administering COVID-19 vaccines:

1. Identify the practice approach to stocking and administering COVID19 vaccines.  There has been a major shift in demand and approach to the COVID19 vaccine since 2021.   The practice should use a cautious approach to stocking the vaccine so as to not over stock the COVID19 vaccine due to inconsistent demand.
2. If stocking the COVID19 vaccine, Integrate the vaccine into Appointment Process – The medical leader for the pediatric practice should determine how the administering of COVID19 will be integrated into visits (i.e. during a scheduled well visit, separate appointment intended only for vaccination and/or via COVID19 vaccine clinics).
3. Suggestions on Calling/Scheduling:  The PediatricXpress system has the ability to send Broadcast email to all families with active emails to announce “COVID-19 vaccine” clinics at the practice.   

Summary:

Pediatric practice leaders should develop a plan customized for their practice including proper monitoring of front desk team members related to eligibility of insurance and medical management approach.