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 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
