Tag: Medicare
Who Would’ve Thought?
Novitas Training on YouTube!
Novitas has made learning more convenient by offering helpful tutorials on YouTube. These short videos provide quick guidance on common Medicare topics, making it easier to find answers without having to attend a full webinar.
HealthSpring Provider Manual 2026
Have you received your copy of the HealthSpring Provider Manual?
UHC December Monthly Overview
Key changes for our Medicare Advantage plan
- In 2026, most UnitedHealthcare Medicare Advantage health maintenance organization (HMO) and point of service (POS) plans are referral plans. You can check plan referral requirements online.
- Starting Jan. 1, 2026, most members enrolled in UnitedHealthcare Medicare Advantage HMO/POS plans will be required to obtain a referral from their primary care provider (PCP) before accessing certain specialist services in outpatient, office or home settings. Referrals must be submitted by the PCP to UnitedHealthcare prior to the specialist visit. This also applies when members of HMO/POS plans are traveling and accessing the National Network. Learn more in our 2026 Medicare Advantage Referral Requirements Guide.
- Effective Jan. 1, 2026, new or existing members of UnitedHealthcare SNPs, including Chronic Special Needs Plans (C-SNP) and Dual Special Needs Plans (D-SNP), need a qualifying chronic condition to access benefits that cover healthy food and/or utilities. Providers may be contacted by UnitedHealthcare to verify a member has at least one qualifying condition to receive benefits. See 2026 Medicare Advantage, CSNP & DSNP Plan Overview Course for more information.
TRS 2025-2026 Plan Year
Products for 2025-2026 Plan Year
Please be aware the Retiree Plans are Calendar Year
ERS 2025-2026 Plan Year
Products for 2025-2026 Plan Year
Please be aware the Retiree Plans are Calendar Year
2025-2026 Flu Season Pricing
Payment Allowances and Effective Dates for the 2025-2026 Flu Season:
CPT Code or HCPCS code
CPT or HCPCS Short Descriptor
Labeler Name
Vaccine/ Procedure Name
National Payment Allowance
Effective Dates
90653
IIV ADJUVANT VACCINE IM
Seqirus
Fluad Trivalent (2025/2026) Preservative Free
$98.160
08/01/2025-07/31/2026
90656
IIV3 VACC NO PRSV 0.5 ML IM
Seqirus
Afluria Trivalent (2025/2026) Preservative Free
$23.215
08/01/2025-07/31/2026
Sanofi Pasteur
Fluzone Trivalent (2025/2026) Preservative Free
08/01/2025-07/31/2026
GlaxoSmithKline
Fluarix Trivalent (2025/2026) Preservative Free
08/01/2025-07/31/2026
FluLaval Trivalent (2025/2026) Preservative Free
08/01/2025-07/31/2026
90657
IIV3 VACCINE SPLT 0.25 ML IM
Seqirus
Afluria Trivalent (2025/2026)
Pediatric Dose
$11.034
08/01/2025-07/31/2026
Sanofi Pasteur
Fluzone Trivalent (2025/2026)
Pediatric Dose
08/01/2025-07/31/2026
90658
IIV3 VACCINE SPLT 0.5 ML IM
Seqirus
Afluria Trivalent (2025/2026
$22.069
08/01/2025-07/31/2026
Sanofi Pasteur
Fluzone Trivalent (2025/2026)
08/01/2025-07/31/2026
90660
LAIV3 VACCINE INTRANASAL
MedImmune
FluMist Trivalent (2025/2026)
$29.714
08/01/2025-07/31/2026
90661
CCIIV3 VAC ABX FR 0.5 ML IM
Seqirus
Flucelvax Trivalent (2025/2026) Preservative Free
$49.495
08/01/2025-07/31/2026
90662
IIV NO PRSV INCREASED AG IM
Sanofi Pasteur
Fluzone High-Dose Trivalent (2025/2026) Preservative Free
$98.160
08/01/2025-07/31/2026
90673
RIV3 VACCINE NO PRESERV IM
Sanofi Pasteur
Flublok Trivalent (2025/2026)
Preservative Free
$98.160
08/01/2025-07/31/2026
Q2039
INFLUENZA VIRUS VACCINE, NOT OTHERWISE SPECIFIED
N/A
N/A
N/A
08/01/2025-07/31/2026
G0008
ADMIN OF FLU VACCINE
N/A
Administration of influenza virus vaccine
Please see below for
Locality-Adjusted Payment Rates
M0201
FLU VACCINE HOME ADMIN
N/A
Administration of influenza vaccine inside a patient’s home; reported only once per individual home per date of service when such vaccine administration(s) are performed at the patient’s home
Please see below for
Locality-Adjusted Payment Rates
| MAC | State | Locality Number | Locality Name | 2025 GAF (with 1.0 Work Floor | G0008 | G0009 | G0010 | M0201 |
| 04412 | TX | 99 | REST OF TEXAS | 0.972 | $ 32.77 | $ 32.77 | $ 32.77 | $ 38.78 |
More from HealthSpring HCSC
New Benefit Plans will roll out under the HealthSpring (HS) name during the 2025 Annual Enrollment Period (AEP)
Beginning in 2026, you will see members enrolled in HealthSpring benefit plans. But until then physician staff and HS will continue to communicate through the Cigna Healthcare Channels, including the Provider Newsroom.
In September of this year (2025) HS will add a home page for providers. After that HS will continue to add resources to prepare the physician office and HS members for January 2026. Check out HealthSpring.com
Superior: Appeal Submissions
IMPORTANT: Post-Service Medical Necessity Appeal Submissions
Superior HealthPlan would like to remind providers that post-service Medical Necessity Appeals must be mailed or faxed using the submission information below. Submissions must include the reason for appeal and any additional clinical information for appeal review..
Centene Management Company
ATTN: Medical Management Appeals
5900 E. Ben White Blvd
Austin, Texas 78741
Fax number: 1-866-918-2266
Post-service appeals for reconsideration of a Medical Necessity Denial on behalf of a member should not be sent to the Claims Appeal address.
For questions about post-service Medical Necessity Appeals, providers can contact 1-877-398-9461.
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