Transcription of Flu Vaccine NDC-to-Procedure Code Crosswalk …
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Flu Vaccine NDC-to-Procedure Code Crosswalk …
Texas Medicaid/CHIP Vendor Drug Program Formulary Management 2015 -16 | Season Flu Vaccine NDC-to-Procedure code Crosswalk Rev. 10/01/ 2015 Page 1 of 1 File: vdp-drg-flundc This Flu Vaccine NDC-to-Procedure code Crosswalk is provided to address questions from MCOs/PBM staff regarding which National Drug Codes (NDC) are covered and not covered per Medicaid covered benefit policy for flu vaccination during the 2015 -16 season. NDC Label Name Procedure code * A Vaccine and toxoid distributed through TVFC** 19515089811 FLULAVAL QUAD 2015 -2016 VIAL 90688 Yes 33332001501 AFLURIA 2015 -2016 SYRINGE 90656 Yes 33332011510 AFLURIA 2015 -2016 VIAL 90658 Yes 42874001510 FLUBLOK 2015 -2016 VIAL 90673 No 49281039615 FLUZONE 2015 -2016 VIAL Q2038 Not a Texas Medicaid benefit 49281039765 FLUZONE HIGH-DOSE 2015 -16 SYR 90662 No 49281041510 FLUZONE QUAD 2015 -2016 VIAL 90686 Yes 49
Texas Medicaid/CHIP Vendor Drug Program Formulary Management 2015-16 | Season Flu Vaccine NDC-to-Procedure Code Crosswalk Rev. 10/01/2015 Page 1 of 1 File: vdp-drg-flundc TxVendorDrug.com
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