Remember – The flu vaccine plus its administration are covered Part B benefits.  CMS has posted the 2011-2012 seasonal flu vaccine payment limits at http://www.CMS.gov/McrPartBDrugAvgSalesPrice/10_VaccinesPricing.asp.  Note that the flu vaccine is NOT a Part D-covered drug.

For more information on coverage and billing of the flu vaccine and its administration, as well as related educational provider resources, visit http://www.CMS.gov/MLNProducts/35_PreventiveServices.asp and http://www.cms.gov/immunizations.

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For dates of service in September 2011, influenza vaccinations are being priced using the 2010-2011 influenza season rates.

What This Means to You

Providers are receiving incorrect payment for influenza vaccination claims. If you identify influenza vaccinations where you were paid incorrectly, please hold your appeal requests. As soon as the pricing files are updated you will be notified and you may request an adjustment of your claims. Until the new pricing files are uploaded National Government Services cannot reprocess any claims. If you have not already submitted your influenza vaccinations for September, please consider holding your claims until the new pricing files are in effect.

Current Status

10/20/2011: National Government Services is aware of this issue and is working in collaboration with the Centers for Medicare & Medicaid Services (CMS) in order to rectify the pricing disparity as soon as possible. Thank you for your patience.

National Government Services, Inc.

Corporate Communications

Flu Prevention is Essential Prenatal Care

Washington, DC — All pregnant women, regardless of trimester, should get the influenza vaccination during the flu season, according to new recommendations issued today by The American College of Obstetricians and Gynecologists and published in the October issue of Obstetrics & Gynecology. The College emphasizes that preventing the flu during pregnancy is an essential element of prenatal care and that it is imperative that physicians, healthcare organizations, and public health officials improve their efforts to increase immunization rates among pregnant women.

Last week, the CDC, along with The College and other medical organizations, encouraged all physicians and health care providers to urge their pregnant and postpartum patients to get vaccinated against the seasonal flu.

Annual flu vaccination is crucial for pregnant women because the immune system changes during pregnancy, which results in women being at increased risk of serious complications if they get the flu. Flu vaccination performs double duty by protecting both pregnant women and their babies. Babies cannot be vaccinated against the flu until they are six months old, but they receive antibodies from their mother which help protect them until they can be vaccinated.

“The flu is a highly infectious virus and can be especially serious for the very young, those with certain medical conditions, and pregnant women,” said Richard N. Waldman, MD, president of The College. “Pregnant women were disproportionately affected by flu complications last year—some went into premature labor, some developed pneumonia, and unfortunately, some died.”

Vaccination early in the flu season is optimal, but can be given at any time during this period, regardless of the stage of pregnancy. The College advises that all women who are or become pregnant during the annual flu season (October through May) get the inactivated flu vaccine. Women can also receive the flu vaccine postpartum and while they are breastfeeding if they missed it during pregnancy. The live attenuated version of the flu vaccine (the nasal mist) should not be given to pregnant women.

According to the CDC, the seasonal flu vaccine is made the same way each year. “The only difference from year to year is that new strains of virus are used to make the vaccine based on which are predicted to be most prevalent,” said William M. Callaghan, MD, the Centers for Disease Control and Prevention (CDC) liaison to The College’s Committee on Obstetric Practice. There have been no studies showing adverse effects of the inactivated flu vaccine for pregnant women or their children, according to The College. “Millions of pregnant women have received the flu vaccine over the past 45 years, and no studies have shown harm to them or their babies,” said Dr. Callaghan.

Despite concerns about thimerosal, a mercury-containing preservative used in some vaccines, there is no scientific evidence that it causes harm to women or their infants. The only side effect is the occasional local skin reaction at the injection site. “There are seasonal flu vaccines that don’t contain thimerosal, so people who remain concerned can ask for those,” said Dr. Callaghan.

Dr. Callaghan notes that The College’s recommendation to increase the vaccination rate among pregnant women dovetails with the CDC’s push for physicians to offer the flu vaccine to every patient age six months and older at every opportunity.

Committee Opinion #468, “Influenza Vaccination During Pregnancy,” is published in the October 2010 issue of Obstetrics & Gynecology.

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The American College of Obstetricians and Gynecologists is the nation’s leading group of physicians providing health care for women. As a private, voluntary, nonprofit membership organization of approximately 55,000 members, The American College of Obstetricians and Gynecologists strongly advocates for quality health care for women, maintains the highest standards of clinical practice and continuing education of its members, promotes patient education, and increases awareness among its members and the public of the changing issues facing women’s health care.

• A/California/7/09 (H1N1)-like virus (pandemic (H1N1) 2009 influenza virus)

• A/Perth /16/2009 (H3N2)-like virus

• B/Brisbane/60/2008-like virus

A higher dose formulation of an inactivated seasonal influenza vaccine (Fluzone High- Dose, manufactured by sanofi pasteur, licensed by FDA on December 23, 2009) for use in people age 65 years and older will also be available in the 2010-11 influenza season. Fluzone High-Dose contains four times the amount of influenza antigen compared to other inactivated seasonal influenza vaccines. Studies are underway to assess the relative effectiveness of Fluzone High-Dose compared to standard dose inactivated influenza vaccine, but results from those studies will not be available before the 2010-11 influenza season. The ACIP has not expressed a preference for Fluzone High-Dose or any other licensed inactivated influenza vaccine for use in people age 65 and older.
All children 6 months through 8 years of age are recommended to receive 2 doses of 2010-11 flu vaccine unless they meet the following conditions (in which case, only 1 dose of influenza vaccine is needed):

• at least 1 dose of 2009 H1N1 vaccine last flu season, and at least 1 dose of seasonal vaccine prior to the 2009-2010 flu season

OR

• at least 1 dose of 2009 H1N1 vaccine last flu season, and 2 doses of seasonal flu vaccine last flu season

If possible, the first dose should be given as soon as vaccine becomes available. The second dose should be given 28 or more days after the first dose. We strongly encourage you to continue in your vaccination efforts against influenza and plan for this upcoming influenza season. Should you need further assistance, please call the NYSDOH Bureau of Immunization at 518-473-4437.
Sincerely,
Guthrie S. Birkhead, M.D., M.P.H.
Deputy Commissioner
Office of Public Health

Five primary changes and updates highlight this 86-page document:

• Routine seasonal influenza vaccination is recommended for all persons aged ≥6 months.

• Two doses, at least four weeks apart, are recommended for all children aged 6 months to 8 years who are receiving seasonal vaccine for the first time. To bring all children into compliance: a) Children should also receive two doses if they were in the age group last year but received only one dose. b) Children in this age group who did not receive at least one dose of H1N1 monovalent vaccine last year should receive two doses of seasonal 2010-2011 vaccine this year regardless of previous vaccine history. c) Children in this age group should also receive two doses of seasonal 2010-2011 vaccine if the type of vaccine they received last year is not known.

• The 2010-2011 trivalent vaccines will contain A/California/7/2009 (H1N1)-like, A/Perth/16/2009 (H3N2)-like, and B/Brisbane/60/2008-like antigens.

• Persons aged ≥65 years can receive the new inactivated trivalent vaccine, Fluzone High-Dose or any of the standard-dose TIV preparations.

• A new inactivated influenza vaccine (Agriflu by Novartis), has been approved for persons aged ≥18 years; and the age indications have been expanded for two previously approved inactivated vaccines (Fluarix by GlaxoSmithKline for persons aged ≥3 years and Afluria by CSL Biotherapies for persons aged ≥6 months).

More information can be accessed online in the complete Morbidity and Mortality Weekly Report (MMWR), Volume 59, titled “Prevention and Control of Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2010.”