There are new influenza vaccine trivalent formulas effective for dates August 1, 2024 through July 31, 2025. These formulas are for children age 0 up to age 19 and for adults ages 19 and up.
Information about vaccines is changing frequently. Please make sure to read the following for more information, including required coverage:
- Centers for Medicare and Medicaid Services (CMS) Vaccine Pricing
- Washington State Health Care Authority (HCA) Physician-Related Services/Health Care Professional Services Billing Guide
- HCA EPSDT Well-Child Program Billing Guide
Vaccines for Children (VFC) Billing
The process for billing childhood vaccines changed recently. This change is only relevant to the Vaccines for Children (VFC) Program. Effective July 1, 2024, the VFC vaccine reimbursement rate increased and an additional payment for procedure codes 90471-90474 was also implemented.
Please submit your claims as follows:
- Bill with the appropriate procedure codes (90471-90474); and
- The VFC vaccine with modifier SL; then
- Bill the vaccine administration (“admin”) code 90471-90474. The admin code does not have a modifier requirement in the EPSDT Well-Child Program Billing Guide; however, providers may bill for the vaccine code and the admin code with modifier SL.
Please note that CHPW’s claims system was recently updated to accept these changes. Given the delay in updating CHPW’s system from the effective date of July 1, 2024, we are in the process of identifying claims that were processed with inappropriate denials, i.e., “separately billed services/tests have been bundled as they are components of the same procedure.” Affected claims will be adjusted by November 15, 2024.
Please read the following for more information:
- HCA Provider Alert dated May 31, 2024, Vaccines For Children (VFC) – VFC Administration billing update, effective July 1, 2024
- HCA Provider Alert dated September 27, 2024, Vaccines for children (VFC) – further billing clarification
- The latest EPSDT Well-Child Program Billing Guide
Questions?
For questions, please contact CHPW’s Customer Service Department:
- Email: [email protected]
- Phone: (800) 440-1561
