Vaccines for Children Policy, Professional · This reimbursement policy applies to services...
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Reimbursement Policy CMS-1500 Policy Number 2020R7109A Proprietary information of UnitedHealthcare Community Plan. Copyright 2020 United HealthCare Services, Inc. 2020R7109A Vaccines for Children Policy, Professional IMPORTANT NOTE ABOUT THIS REIMBURSEMENT POLICY You are responsible for submission of accurate claims. This reimbursement policy is intended to ensure that you are reimbursed based on the code or codes that correctly describe the health care services provided. UnitedHealthcare Community Plan reimbursement policies uses Current Procedural Terminology (CPT ® *), Centers for Medicare and Medicaid Services (CMS) or other coding guidelines. References to CPT or other sources are for definitional purposes only and do not imply any right to reimbursement. This reimbursement policy applies to all health care services billed on CMS 1500 forms and, when specified, to those billed on UB04 forms. Coding methodology, industry-standard reimbursement logic, regulatory requirements, benefits design and other factors are considered in developing reimbursement policy. This information is intended to serve only as a general reference resource regarding UnitedHealthcare Community Plan’s reimbursement policy for the services described and is not intended to address every aspect of a reimbursement situation. Accordingly, UnitedHealthcare Community Plan may use reasonable discretion in interpreting and applying this policy to health care services provided in a particular case. Further, the policy does not address all issues related to reimbursement for health care services provided to UnitedHealthcare Community Plan enrollees. Other factors affecting reimbursement supplement, modify or, in some cases, supersede this policy. These factors include, but are not limited to: federal &/or state regulatory requirements, the physician or other provider contracts, the enrollee’s benefit coverage documents, and/or other reimbursement, medical or drug policies. Finally, this policy may not be implemented exactly the same way on the different electronic claims processing systems used by UnitedHealthcare Community Plan due to programming or other constraints; however, UnitedHealthcare Community Plan strives to minimize these variations. UnitedHealthcare Community Plan may modify this reimbursement policy at any time by publishing a new version of the policy on this Website. However, the information presented in this policy is accurate and current as of the date of publication. *CPT Copyright American Medical Association. All rights reserved. CPT® is a registered trademark of the American Medical Association. Application This reimbursement policy applies to UnitedHealthcare Community Plan Medicaid Product. This reimbursement policy applies to services reported using the 1500 Health Insurance Claim Form (a/k/a CMS-1500) or its electronic equivalent or its successor form. This policy applies to all products and all network and non-network physicians and other qualified health care professionals, including, but not limited to, non-network authorized and percent of charge contract physicians and other qualified health care professionals. Policy Overview The Vaccines for Children (VFC) program was established in 1993 to serve children defined as "federally vaccine eligible" under section 1928(b)(2), which includes both "uninsured" and "Medicaid eligible" children. American Indian, Alaskan Native children and children whose insurance does not cover immunizations are also eligible for VFC. States will continue to receive federal funding for reduced-price vaccines under this program. All children from birth through 18 years of age (18 years + 364 days) who are covered by Medicaid are considered VFC eligible because of their Medicaid status. The Advisory Committee on Immunization Practices (ACIP) is a federal advisory committee whose role is to provide advice and guidance to the Secretary and the Assistant Secretary for Health and Human Services, and the Director, Centers for Disease Control and Prevention (CDC), regarding the most appropriate selection of vaccines and related agents for control of vaccine-preventable diseases in the civilian population of the United States. Immunization programs that receive VFC funds are required to implement ACIP-recommended vaccines for which there are VFC resolutions and for which federal contracts have been established to purchase these vaccines. The ACIP proposes that vaccines to prevent the following diseases be included in the Vaccines for Children (VFC) program:
Transcript of Vaccines for Children Policy, Professional · This reimbursement policy applies to services...
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Reimbursement Policy
CMS-1500 Policy Number 2020R7109A
Proprietary information of UnitedHealthcare Community Plan. Copyright 2020 United HealthCare Services, Inc. 2020R7109A
Vaccines for Children Policy, Professional
IMPORTANT NOTE ABOUT THIS REIMBURSEMENT POLICY You are responsible for submission of accurate claims. This reimbursement policy is intended to ensure that you are reimbursed based on the code or codes that correctly describe the health care services provided. UnitedHealthcare Community Plan reimbursement policies uses Current Procedural Terminology (CPT®*), Centers for Medicare and Medicaid Services (CMS) or other coding guidelines. References to CPT or other sources are for definitional purposes only and do not imply any right to reimbursement. This reimbursement policy applies to all health care services billed on CMS 1500 forms and, when specified, to those billed on UB04 forms. Coding methodology, industry-standard reimbursement logic, regulatory requirements, benefits design and other factors are considered in developing reimbursement policy. This information is intended to serve only as a general reference resource regarding UnitedHealthcare Community Plan’s reimbursement policy for the services described and is not intended to address every aspect of a reimbursement situation. Accordingly, UnitedHealthcare Community Plan may use reasonable discretion in interpreting and applying this policy to health care services provided in a particular case. Further, the policy does not address all issues related to reimbursement for health care services provided to UnitedHealthcare Community Plan enrollees. Other factors affecting reimbursement supplement, modify or, in some cases, supersede this policy. These factors include, but are not limited to: federal &/or state regulatory requirements, the physician or other provider contracts, the enrollee’s benefit coverage documents, and/or other reimbursement, medical or drug policies. Finally, this policy may not be implemented exactly the same way on the different electronic claims processing systems used by UnitedHealthcare Community Plan due to programming or other constraints; however, UnitedHealthcare Community Plan strives to minimize these variations. UnitedHealthcare Community Plan may modify this reimbursement policy at any time by publishing a new version of the policy on this Website. However, the information presented in this policy is accurate and current as of the date of publication. *CPT Copyright American Medical Association. All rights reserved. CPT® is a registered trademark of the American Medical Association.
Application
This reimbursement policy applies to UnitedHealthcare Community Plan Medicaid Product. This reimbursement policy applies to services reported using the 1500 Health Insurance Claim Form (a/k/a CMS-1500) or its electronic equivalent or its successor form. This policy applies to all products and all network and non-network physicians and other qualified health care professionals, including, but not limited to, non-network authorized and percent of charge contract physicians and other qualified health care professionals.
Policy
Overview
The Vaccines for Children (VFC) program was established in 1993 to serve children defined as "federally vaccine eligible" under section 1928(b)(2), which includes both "uninsured" and "Medicaid eligible" children. American Indian, Alaskan Native children and children whose insurance does not cover immunizations are also eligible for VFC. States will continue to receive federal funding for reduced-price vaccines under this program. All children from birth through 18 years of age (18 years + 364 days) who are covered by Medicaid are considered VFC eligible because of their Medicaid status.
The Advisory Committee on Immunization Practices (ACIP) is a federal advisory committee whose role is to provide advice and guidance to the Secretary and the Assistant Secretary for Health and Human Services, and the Director, Centers for Disease Control and Prevention (CDC), regarding the most appropriate selection of vaccines and related agents for control of vaccine-preventable diseases in the civilian population of the United States.
Immunization programs that receive VFC funds are required to implement ACIP-recommended vaccines for which there are VFC resolutions and for which federal contracts have been established to purchase these vaccines.
The ACIP proposes that vaccines to prevent the following diseases be included in the Vaccines for Children (VFC) program:
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Reimbursement Policy
CMS-1500 Policy Number 2020R7109A
Proprietary information of UnitedHealthcare Community Plan. Copyright 2020 United HealthCare Services, Inc. 2020R7109A
Diphtheria
Haemophilus influenza type b
Hepatitis A
Hepatitis B Human
Papillomavirus
Influenza
Measles
Meningococcal
Mumps
Pertussis (whooping cough)
Pneumococcal
Poliomyelitis
Rotavirus
Rubella
Tetanus
Varicella
The ACIP includes in the Vaccines for Children program vaccines which are used to prevent the 16 diseases listed above; to be administered as provided in other VFC resolutions.
Generally, only combined antigen vaccines - such as MMR or DTaP - will be provided through the VFC Program. Single antigen vaccines will be available and related administration fees reimbursable only when a normally appropriate combined antigen is contraindicated and documented in the member’s medical records.
While Influenza vaccine is part of the VFC program, the influenza vaccine (“flu shot”) is generally ordered separately from other VFC vaccines. Flu vaccine is ordered on a different schedule as it is not a vaccine supplied year round. Many states have Influenza vaccination programs in addition to VFC program.
The Healthcare Effectiveness Data and Information Set (HEDIS) is a widely used set of performance measures in the managed care industry, developed and maintained by the National Committee for Quality Assurance (NCQA). HEDIS measures address a broad range of important health issues including Childhood and Adolescent Immunization Status.
Reimbursement Guidelines
Through this policy, UnitedHealthcare Community Plan will ensure compliance with the federally mandated Vaccines For Children program, while reducing inappropriate payments where providers have access to free vaccines for children enrolled in Medicaid, and also meet all State specific requirements. This policy applies to members under age 19 only (age 18 + 364 days). As part of the Patient Protection and Affordable Care Act (PPACA) regulations the Centers for Medicare & Medicaid Services (CMS) require Medicaid programs to reimburse for VFC services on administration codes 90460, 90471, 90472, 90473, and/or 90474 rather than the serum/toxoid code. Per the PPACA legislation, CPT code 90461 is NOT reimbursable for VFC services. Some States have determined to pay all of these administration codes (except 90461), some only 90460. Any variations from this are listed under the State Exceptions portion of this policy. Please refer to the communication posted by your State Fee for Service Medicaid Plan for further details on which administration codes are payable in each State and which immunizations are considered part of the VFC program in each State. The vaccine code(s) and administration code(s) may be submitted on separate claims, but the claims must be for the same date of service by the same provider and the number of units for each must match. Excessive units of either code(s) will be denied – i.e. 90658 (vaccine) – 1 unit. 90471 (administration) – 1 unit 90696 (vaccine) – 1 unit 90472 (administration) – 2 units – 1 unit would deny as there is no corresponding vaccine code billed. ***Administration codes should be billed on one line with multiple units wherever possible to avoid duplicate denials.
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Reimbursement Policy
CMS-1500 Policy Number 2020R7109A
Proprietary information of UnitedHealthcare Community Plan. Copyright 2020 United HealthCare Services, Inc. 2020R7109A
Some States require that modifiers be appended to the serum code (s) and/or the vaccine administration code(s). Please refer to the communication posted by your State Fee for Service Medicaid Plan for further details for modifier requirements of each State.
State Exceptions
Arizona The SL modifier must be appended to the vaccine administration code and the serum code. If the SL modifier is not appended, both the administration and serum codes will be denied. Per State Regulations, the serum code should be billed with a $0.00 charge.
California Per State Regulations:
California requires the SL modifier be appended to the vaccines serum code. If the SL modifier is not appended, the serum code will not be counted and the corresponding administration code will be denied.
California will only reimburse administration code 90471 for VFC related vaccines.
Code 90644, 90620 & 90621 needs to be billed with an SK modifier or SK and SL but not SL alone.
Code 90734 needs to be billed with modifiers SK and SL for children 0 to 10 but only with SL modifier for children 11 to 18.
Florida The Florida Healthy Kids and MediKids product does not participate in the VFC program.
Iowa Effective 5/20/2018 only administration CPT codes 90460 and 90461 are utilized for VFC. CPT 90460 should list one unit for each vaccine administered. CPT 90461 should be billed for informational purposes only and billed at $0.00 indicating any remaining components.
Kansas Kansas Medicaid claims submitted with modifier SL will be denied unless the federal government has announced a vaccine shortage through the VFC program.
Maryland Maryland requires the SE modifier to be appended to the vaccine serum code effective with dates of service as of 9/1/13. If the modifier is not appended with dates of service on or after 9/1/13, the serum code will be denied. Per State Regulation, Maryland pays on the serum code rather than the vaccine administration code. The administration code is not required to be on the claim.
Massachusetts Massachusetts Senior Care Options (SCO) Plan is for individuals who are 65 and over and they do not enroll any children. The VFC program does not apply to Massachusetts.
Mississippi The EP modifier must be appended to the vaccine administration code and the serum code for MSCAN. If the EP modifier is not appended for MSCAN, both the administration and serum codes will be denied. CPT 90715 may be billed without the EP modifier for pregnant patients under 19 years of age.
Missouri Missouri requires the SL modifier be appended to the vaccine serum code. If the SL modifier is not appended, the serum code will be denied. Per State Regulation, Missouri pays on the serum code rather than the vaccine administration code. The administration code is not required to be on the claim. Missouri CHIP members should not be excluded from VFC.
Nebraska Nebraska requires the SL modifier be appended to the vaccine serum code. If the SL modifier is not appended, the serum code will be denied.
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Reimbursement Policy
CMS-1500 Policy Number 2020R7109A
Proprietary information of UnitedHealthcare Community Plan. Copyright 2020 United HealthCare Services, Inc. 2020R7109A
State Exceptions
Per State Regulation, Nebraska pays on the serum code rather than the vaccine administration code. The administration code is not required to be on the claim. Nebraska’s SCHIP product does not participate in the VFC program.
New Jersey Medicaid members in New Jersey’s FamilyCare Plans B, C, and D are excluded from this policy.
New York New York requires the SL modifier be appended to the vaccine serum code. If the SL modifier is not appended, the serum code will not be counted and the corresponding administration code will be denied. New York will only reimburse administration code 90460 for VFC related vaccines.
North Carolina Per state regulations, modifier EP is required for vaccine administration and serum codes. North Carolina CHIP members do not participate in the VFC program.
Pennsylvania Pennsylvania’s CHIP product does not participate in the VFC program.
Rhode Island The serum code is not required to be on the claim. Effective 5/1/2016, administration code 90461 is covered for VFC related vaccines.
Texas Administration code 90461 is covered for VFC related vaccines. Texas providers are required to bill multiple duplicate admin codes on a single claim.
Virginia Virginia pays on the serum code rather than the vaccine administration code. The administration code is not required to be on the claim. Virginia FAMIS product does not participate in the VFC program.
Washington Washington state requires the SL modifier be appended to the vaccine serum code. If the SL modifier is not appended, the serum code will be denied. Per State Regulation, Washington pays on the serum code rather than the vaccine administration code. The administration code is not required to be on the claim.
Wisconsin Per State Regulation, Wisconsin pays on the serum code rather than the vaccine administration code. The administration code is not required to be on the claim.
Definitions
CHIP Children’s Health Insurance Program
Modifier SE State or Federally Funded Program
Modifier SL State Supplied
VFC Vaccines for Children
Questions and Answers
1
Q: What are PPACA and VFC? A: PPACA is the Patient Protection and Affordable Care Act (Healthcare Reform initiative) and VFC is the Vaccines for Children Program.
2 Q: What has changed?
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Reimbursement Policy
CMS-1500 Policy Number 2020R7109A
Proprietary information of UnitedHealthcare Community Plan. Copyright 2020 United HealthCare Services, Inc. 2020R7109A
A: As part of the PPACA Regulations, changes take effect Jan. 1, 2013 regarding increased reimbursement to qualified providers for certain CPT codes. As part of this increase, the Centers for Medicare & Medicaid Services (CMS) requires state Medicaid programs to reimburse for VFC services on administration codes 90460, 90471, 90472, 90473, and/or 90474 rather than the serum/toxoid code.
3 Q: Are there any States that have determined to pay differently than referenced in Question 2? A: Yes, those States are listed in the “State Exceptions” portion of this policy document.
Attachments: Please right-click on the icon to open the file
VFC Serum-Toxoid Codes List
List of VFC Serum-Toxoid Codes
VFC Administration Codes List
List of VFC Administration Codes
Resources
Individual state Medicaid regulations, manuals & fee schedules American Medical Association, Current Procedural Terminology ( CPT® ) Professional Edition and associated publications and services Centers for Medicare and Medicaid Services, CMS Manual System and other CMS publications and services Centers for Medicare and Medicaid Services, Healthcare Common Procedure Coding System, HCPCS Release and Code Sets
History
1/1/2020 Policy Version Change State Exception Section: Removed Hawaii
12/1/2019 Policy Version Change State Exception Section: Removed Ohio Attachment Section: Updated Administration Codes List and Serum-Toxoid Codes List for Ohio
10/23/2019 Policy Version Change State Exception Section: Removed New Mexico Attachment Section: Updated Serum-Toxoid Codes List for Arizona
10/16/2019 Policy Version Change Attachment Section: Updated Administration Codes List and Serum-Toxoid Codes List for New York
10/7/2019 Policy Verbiage Change State Exception Section: Verbiage updated for Mississippi
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2019 VFC Serum Toxoid Codes List
Serum State
90371 AZ
90476 IA
90476 HI
90477 IA
90477 HI
90581 IA
90581 HI
90585 HI
90585 IA
90585 NY
90586 HI
90586 IA
90586 NY
90620 TN
90620 WA
90620 MI
90620 VA
90620 OH
90620 TX
90620 MD
90620 AZ
90620 NM
90620 MS
90620 NJ
90620 FL
90620 NE
90620 IA
90620 NY
90620 KS
90620 PA
90620 MO
90620 OH
90621 VA
90621 TX
90621 AZ
90621 WA
90621 FL
90621 IA
90621 KS
90621 MO
90621 MI
90621 MD
90621 NJ
90621 MS
90621 OH
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90621 NY
90621 NM
90621 TN
90621 PA
90621 OH
90630 TX
90630 IA
90630 MD
90630 NE
90630 AZ
90632 NY
90632 RI
90632 TX
90632 WI
90632 IA
90632 HI
90632 LA
90632 NJ
90633 NE
90633 NY
90633 NJ
90633 NM
90633 MD
90633 MI
90633 MO
90633 KS
90633 VA
90633 OH
90633 MS
90633 TX
90633 TN
90633 WA
90633 CA
90633 AZ
90633 FL
90633 DE
90633 WI
90633 RI
90633 IA
90633 PA
90633 HI
90633 LA
90633 OH
90634 KS
90634 OH
90634 DE
90634 FL
-
90634 HI
90634 NM
90634 IA
90634 TN
90634 PA
90634 WI
90634 OH
90636 NY
90636 TX
90636 IA
90636 DE
90636 HI
90636 PA
90636 WI
90644 NJ
90644 TX
90644 CA
90644 AZ
90644 WA
90644 DE
90644 IA
90644 RI
90644 OH
90644 MS
90644 VA
90644 MI
90644 MO
90644 KS
90644 HI
90644 OH
90645 OH
90645 MS
90645 OH
90646 MS
90646 OH
90646 OH
90647 RI
90647 OH
90647 PA
90647 NM
90647 NY
90647 MS
90647 NE
90647 NJ
90647 MD
90647 MI
90647 MO
-
90647 KS
90647 HI
90647 IA
90647 WI
90647 DE
90647 FL
90647 AZ
90647 CA
90647 WA
90647 TN
90647 TX
90647 VA
90647 OH
90648 KS
90648 OH
90648 PA
90648 NM
90648 NY
90648 MS
90648 NE
90648 NJ
90648 MD
90648 MI
90648 MO
90648 VA
90648 LA
90648 HI
90648 IA
90648 WI
90648 DE
90648 FL
90648 AZ
90648 CA
90648 WA
90648 TN
90648 TX
90648 OH
90649 OH
90649 PA
90649 NJ
90649 NM
90649 NY
90649 MS
90649 NE
90649 MD
90649 MI
90649 MO
-
90649 KS
90649 LA
90649 HI
90649 IA
90649 WI
90649 DE
90649 FL
90649 AZ
90649 CA
90649 WA
90649 TN
90649 TX
90649 RI
90649 OH
90650 FL
90650 LA
90650 HI
90650 IA
90650 WI
90650 DE
90650 AZ
90650 CA
90650 WA
90650 TN
90650 TX
90650 OH
90650 PA
90650 NJ
90650 NM
90650 NY
90650 MS
90650 NE
90650 MD
90650 MO
90650 KS
90650 OH
90651 VA
90651 LA
90651 FL
90651 IA
90651 WA
90651 AZ
90651 CA
90651 TN
90651 TX
90651 OH
90651 PA
-
90651 NJ
90651 NY
90651 MS
90651 NE
90651 MD
90651 MI
90651 MO
90651 KS
90651 OH
90653 IA
90653 KS
90653 NY
90653 OH
90654 IA
90654 PA
90654 HI
90654 KS
90654 TX
90654 NM
90654 NE
90654 NY
90655 LA
90655 KS
90655 FL
90655 HI
90655 IA
90655 WI
90655 DE
90655 AZ
90655 CA
90655 WA
90655 TN
90655 TX
90655 OH
90655 PA
90655 NM
90655 NY
90655 MS
90655 NE
90655 MD
90655 MI
90655 OH
90656 LA
90656 KS
90656 FL
90656 HI
90656 IA
-
90656 WI
90656 DE
90656 AZ
90656 CA
90656 WA
90656 TN
90656 TX
90656 OH
90656 PA
90656 NM
90656 NY
90656 MS
90656 NE
90656 MD
90656 MI
90656 MO
90656 OH
90657 LA
90657 KS
90657 FL
90657 HI
90657 WI
90657 DE
90657 AZ
90657 CA
90657 WA
90657 TN
90657 TX
90657 OH
90657 PA
90657 NM
90657 NY
90657 MS
90657 NE
90657 MD
90657 MI
90657 IA
90657 OH
90658 LA
90658 KS
90658 FL
90658 HI
90658 WA
90658 WI
90658 DE
90658 AZ
90658 CA
-
90658 TN
90658 TX
90658 OH
90658 PA
90658 NM
90658 NY
90658 MS
90658 NE
90658 MD
90658 MI
90658 IA
90658 OH
90660 TN
90660 AZ
90660 OH
90660 CA
90660 DE
90660 WI
90660 WA
90660 HI
90660 FL
90660 TX
90660 IA
90660 MD
90660 NE
90660 NY
90660 NM
90660 PA
90660 OH
90661 TN
90661 TX
90661 HI
90661 PA
90661 IA
90661 NY
90662 TN
90662 HI
90662 IA
90662 NY
90663 TN
90664 HI
90664 IA
90664 OH
90664 OH
90666 IA
90666 OH
90666 HI
-
90666 OH
90667 HI
90667 OH
90667 IA
90667 OH
90668 HI
90668 IA
90668 OH
90668 OH
90669 OH
90669 HI
90669 IA
90669 OH
90670 RI
90670 OH
90670 PA
90670 NJ
90670 NM
90670 NY
90670 MS
90670 NE
90670 MD
90670 MI
90670 MO
90670 IA
90670 KS
90670 LA
90670 FL
90670 HI
90670 WA
90670 WI
90670 DE
90670 AZ
90670 CA
90670 TN
90670 TX
90670 VA
90670 OH
90672 RI
90672 OH
90672 TX
90672 TN
90672 CA
90672 AZ
90672 DE
90672 WA
90672 FL
-
90672 KS
90672 MO
90672 MI
90672 MD
90672 MS
90672 NY
90672 PA
90672 OH
90673 TX
90673 OH
90673 NY
90673 OH
90674 HI
90674 VA
90674 KS
90674 NJ
90674 NM
90674 AZ
90674 NY
90674 MO
90674 MS
90674 DE
90674 IA
90674 TN
90674 MD
90674 OH
90675 IA
90675 HI
90675 NY
90676 IA
90676 HI
90676 NY
90680 LA
90680 KS
90680 IA
90680 MI
90680 MD
90680 NE
90680 MS
90680 MO
90680 NY
90680 NM
90680 NJ
90680 PA
90680 OH
90680 TX
90680 TN
-
90680 AZ
90680 VA
90680 DE
90680 CA
90680 WI
90680 WA
90680 HI
90680 FL
90680 OH
90681 DE
90681 KS
90681 MO
90681 TX
90681 MI
90681 TN
90681 NY
90681 AZ
90681 NE
90681 VA
90681 NM
90681 RI
90681 IA
90681 CA
90681 NJ
90681 WI
90681 MS
90681 WA
90681 PA
90681 MD
90681 FL
90681 OH
90681 LA
90681 OH
90682 NY
90685 RI
90685 KS
90685 LA
90685 FL
90685 CA
90685 DE
90685 VA
90685 WA
90685 AZ
90685 TN
90685 TX
90685 OH
90685 PA
-
90685 NJ
90685 NY
90685 MO
90685 MS
90685 NE
90685 MD
90685 MI
90685 IA
90685 OH
90686 OH
90686 KS
90686 PA
90686 MD
90686 TX
90686 NJ
90686 RI
90686 CA
90686 LA
90686 DE
90686 TN
90686 NE
90686 VA
90686 IA
90686 MS
90686 WA
90686 MI
90686 MO
90686 AZ
90686 FL
90686 NY
90686 OH
90687 TX
90687 TN
90687 AZ
90687 WA
90687 VA
90687 DE
90687 FL
90687 KS
90687 IA
90687 MI
90687 MD
90687 LA
90687 NE
90687 MS
90687 NJ
90687 PA
-
90687 OH
90687 OH
90688 WA
90688 MO
90688 VA
90688 KS
90688 MS
90688 DE
90688 IA
90688 NE
90688 CA
90688 MI
90688 LA
90688 MD
90688 TN
90688 PA
90688 NJ
90688 AZ
90688 FL
90688 TX
90688 OH
90688 NY
90688 OH
90690 HI
90690 IA
90690 NY
90691 HI
90691 NY
90696 AZ
90696 MD
90696 VA
90696 PA
90696 DE
90696 CA
90696 NM
90696 WI
90696 NE
90696 WA
90696 RI
90696 NY
90696 TN
90696 MI
90696 TX
90696 OH
90696 LA
90696 MS
90696 IA
-
90696 MO
90696 KS
90696 NJ
90696 FL
90696 OH
90697 AZ
90698 TX
90698 TN
90698 AZ
90698 VA
90698 DE
90698 CA
90698 WI
90698 WA
90698 HI
90698 FL
90698 KS
90698 IA
90698 MI
90698 MD
90698 LA
90698 NE
90698 MS
90698 MO
90698 NY
90698 NM
90698 NJ
90698 PA
90698 OH
90698 OH
90700 NE
90700 TX
90700 PA
90700 HI
90700 FL
90700 MD
90700 DE
90700 CA
90700 MO
90700 WI
90700 OH
90700 WA
90700 MS
90700 AZ
90700 NY
90700 VA
90700 MI
-
90700 IA
90700 LA
90700 KS
90700 RI
90700 NJ
90700 TN
90700 NM
90700 OH
90702 IA
90702 HI
90702 DE
90702 WI
90702 WA
90702 AZ
90702 VA
90702 TX
90702 TN
90702 RI
90702 PA
90702 OH
90702 NY
90702 NM
90702 MS
90702 MO
90702 MD
90702 MI
90702 LA
90702 KS
90702 OH
90703 OH
90703 OH
90707 MI
90707 MO
90707 MS
90707 NE
90707 NJ
90707 NM
90707 NY
90707 OH
90707 PA
90707 RI
90707 TN
90707 TX
90707 VA
90707 AZ
90707 WA
90707 WI
-
90707 CA
90707 DE
90707 FL
90707 HI
90707 IA
90707 KS
90707 LA
90707 MD
90707 OH
90709 WI
90710 MS
90710 NE
90710 NJ
90710 NM
90710 NY
90710 PA
90710 RI
90710 TN
90710 TX
90710 VA
90710 AZ
90710 WA
90710 MD
90710 MI
90710 MO
90710 WI
90710 CA
90710 DE
90710 FL
90710 HI
90710 IA
90710 KS
90710 LA
90710 OH
90713 RI
90713 TN
90713 TX
90713 VA
90713 AZ
90713 WA
90713 WI
90713 CA
90713 DE
90713 FL
90713 HI
90713 IA
90713 KS
-
90713 LA
90713 MD
90713 MI
90713 MO
90713 MS
90713 NE
90713 NJ
90713 NM
90713 NY
90713 OH
90713 PA
90713 OH
90714 RI
90714 TN
90714 TX
90714 OH
90714 PA
90714 MI
90714 MO
90714 MS
90714 NE
90714 NJ
90714 NM
90714 FL
90714 HI
90714 IA
90714 KS
90714 LA
90714 MD
90714 VA
90714 AZ
90714 WA
90714 WI
90714 CA
90714 DE
90714 NY
90714 OH
90715 TX
90715 FL
90715 KS
90715 VA
90715 NY
90715 CA
90715 NM
90715 TN
90715 NJ
90715 LA
-
90715 AZ
90715 NE
90715 RI
90715 MS
90715 OH
90715 PA
90715 WI
90715 MD
90715 HI
90715 IA
90715 DE
90715 MI
90715 WA
90715 MO
90715 OH
90716 HI
90716 FL
90716 NY
90716 NM
90716 NJ
90716 NE
90716 MS
90716 MO
90716 MI
90716 MD
90716 PA
90716 OH
90716 TX
90716 TN
90716 RI
90716 WI
90716 CA
90716 DE
90716 WA
90716 AZ
90716 VA
90716 LA
90716 KS
90716 IA
90716 OH
90717 HI
90717 IA
90717 NY
90718 PA
90718 WI
90718 TN
90718 LA
-
90718 NE
90721 MS
90721 OH
90721 OH
90723 MS
90723 NE
90723 NJ
90723 NM
90723 NY
90723 FL
90723 HI
90723 IA
90723 KS
90723 LA
90723 VA
90723 AZ
90723 WA
90723 CA
90723 DE
90723 WI
90723 MO
90723 MI
90723 MD
90723 TX
90723 OH
90723 PA
90723 RI
90723 TN
90723 OH
90732 OH
90732 KS
90732 TX
90732 TN
90732 RI
90732 PA
90732 DE
90732 WA
90732 AZ
90732 VA
90732 IA
90732 HI
90732 FL
90732 MD
90732 MI
90732 MO
90732 MS
90732 NE
-
90732 NJ
90732 NM
90732 NY
90732 OH
90733 PA
90733 TN
90733 DE
90733 NE
90733 HI
90733 OH
90733 KS
90733 TX
90733 IA
90733 NY
90733 OH
90734 NY
90734 OH
90734 MD
90734 MI
90734 MO
90734 NE
90734 NJ
90734 NM
90734 FL
90734 HI
90734 IA
90734 KS
90734 LA
90734 VA
90734 AZ
90734 WA
90734 CA
90734 DE
90734 WI
90734 PA
90734 RI
90734 TN
90734 TX
90734 OH
90735 HI
90735 IA
90736 HI
90736 IA
90736 NY
90738 NY
90739 NY
90740 HI
-
90740 TN
90740 WI
90740 IA
90740 DE
90740 NY
90743 DE
90743 WI
90743 TN
90743 TX
90743 NY
90743 MD
90743 NJ
90743 NM
90743 FL
90743 HI
90743 IA
90743 KS
90743 VA
90743 WA
90743 CA
90743 PA
90744 DE
90744 NE
90744 PA
90744 RI
90744 TN
90744 TX
90744 NY
90744 OH
90744 MD
90744 MI
90744 MO
90744 WI
90744 NJ
90744 NM
90744 FL
90744 HI
90744 IA
90744 KS
90744 LA
90744 VA
90744 AZ
90744 WA
90744 CA
90744 OH
90745 AZ
90745 IA
-
90746 DE
90746 NJ
90746 RI
90746 NE
90746 WI
90746 HI
90746 IA
90746 LA
90746 TX
90746 NY
90747 DE
90747 TN
90747 PA
90747 WI
90747 HI
90747 IA
90747 WA
90747 NY
90748 DE
90748 PA
90748 TN
90748 NY
90748 MD
90748 MI
90748 NE
90748 NJ
90748 FL
90748 HI
90748 IA
90748 KS
90748 TX
90748 WA
90748 CA
90748 WI
90749 WI
90749 MS
90749 PA
90749 TX
90749 HI
90749 IA
90749 NY
90750 AZ
90750 NY
90756 IA
90756 TN
90756 AZ
90756 NY
-
Q2035 WA
Q2035 KS
Q2036 KS
Q2036 IA
Q2037 WA
Q2037 IA
Q2037 KS
Q2038 KS
Q2038 IA
Q2039 KS
Q2039 IA
112219_VFC Serum-Toxoid Code List_2019.pdf
-
2019 VFC Administration Codes List
Admin State
90460 AZ
90460 TX
90460 PA
90460 NY
90460 MI
90460 IA
90460 CA
90460 OH
90461 TX
90461 IA
90471 AZ
90471 TX
90471 LA
90471 MI
90471 PA
90471 CA
90472 AZ
90472 LA
90472 TX
90472 PA
90472 MI
90473 MI
90473 LA
90473 AZ
90473 PA
90474 MI
90474 LA
90474 AZ
90474 PA
90474 TX
G0008 AZ
G0008 MI
G0008 PA
G0009 PA
G0009 AZ
G0010 AZ
112219_VFC Admin Code List_2019.pdf
-
Reimbursement Policy
CMS-1500 Policy Number 2020R7109A
Proprietary information of UnitedHealthcare Community Plan. Copyright 2020 United HealthCare Services, Inc. 2020R7109A
9/22/2019 Attachment Section: Added CPT code 90630 for Arizona Attachment Section: Deleted CPT code 90722 for Tennessee
8/18/2019 Attachment Section: Added verbiage for North Carolina
8/11/2019 Attachment Section: Added CPT Serum Code 90756 for Arizona
8/2/2019 Annual Anniversary Date and Version Change Removed Annual Approval Information and Moved Policy Number to the Header
5/19/2019 State Exception Section: California state exceptions updated
4/11/2019 Attachments section: List of VFC Serum-Toxoid and Administration Codes updated
3/31/2019 State Exception Section: Florida state exceptions updated
1/1/2019 Attachments section: List of VFC Serum-Toxoid and Administration Codes updated
12/2/2018 Policy Approval Date Change (no new version) History Section: Entries prior to 1/1/17 archived
11/11/2018 Virginia state exceptions updated. Attachments section: List of VFC Serum-Toxoid and Administration Codes updated
9/15/2018 Application section updated per legal update
8/19/2018 VFC Serum-Toxoid and Admin Code List updated
7/16/2018 VFC Serum-Toxoid and Admin Code List updated
7/8/2018 VFC Serum-Toxoid and Admin Code List updated
6/20/2018 Attachments section: Updated the VFC Serum-Toxoid and Admin Code List (for Texas)
5/30/2018 Attachments section: Updated the VFC Serum-Toxoid and Admin Code List (for Virginia)
5/20/2018 State Exceptions section: Iowa state exception updated to add the language Effective 5/20/2018 Attachments section: Updated the VFC Serum-Toxoid and Admin Code List (for Iowa)
4/19/2018 Questions and Answers section: Removed code 90461 from the question 2 answer. Attachments section: Updated the VFC Serum-Toxoid and Admin Code List to remove code 90461 from header line 2.
4/8/2018 VFC Serum-Toxoid and Admin Code List updated
3/25/2018 Iowa state exceptions added in addition the VFC Serum-Toxoid and Admin Code List updated
2/18/2018 VFC National VFC Serum-Toxoid and Admin list updated
1/1/2018 Annual Version Change History Section: Entries prior to 1/1/2015 were archived
11/8/2017 Policy Approval Date Change (no new version)
10/8/2017 Attachments Section: Updated list of applicable ICD-10 diagnosis codes
7/18/2017 Application Section: Removed UnitedHealthcare Community Plan Medicare products as applying to this policy. Added location for UnitedHealthcare Community Plan Medicare reimbursement policies
-
Reimbursement Policy
CMS-1500 Policy Number 2020R7109A
Proprietary information of UnitedHealthcare Community Plan. Copyright 2020 United HealthCare Services, Inc. 2020R7109A
2/19/2017 Codes Section: Added code G0499
1/1/2017 Annual Version Change Policy Verbiage Section: Overview section updated to remove reference to ICD-9 CM Question and Answers Section: updated to remove reference to ICD-9 CM Attachment Section: Updated to remove the ICD-9 CM Codes List History Section: Entries prior to 1/1/2015 archived
12/8/2007 Policy implemented by UnitedHealthcare Community Plan
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