State of Idaho Vaccines for Children Program gets a booster

The State of Idaho Immunization Program (IIP) administers the federal Vaccines for Children Program (VFC) supplying childhood vaccine products for eligible children. The IIP has also supplied non-VFC childhood vaccine products for Idaho children not eligible for VFC vaccines.

The Idaho Legislature has passed and Governor Otter has signed legislation providing for non-VFC childhood vaccine products to continue to be supplied to providers by the IIP. Effective April 1, 2010, these non-VFC vaccine products will be purchased with funds from assessments from insurers. 

Providers should refer to the Idaho Immunization Program for up-to-date information regarding procedures for obtaining both VFC and non-VFC vaccine products.

Providers should use state-supplied vaccine products to immunize VFC-eligible children regardless of resident status. Providers should use state-supplied vaccine products to immunize insured children who are younger than 19 years old and Idaho residents. A child whose custodial parent or legal guardian resides in Idaho is considered to be an Idaho resident.

For accuracy and program compliance, providers should now report all state-supplied (both VFC and non-VFC) vaccine products administered by billing $0.01 for the appropriate Vaccination Product CPT code (CPT code range 90476-90749) with modifier "SL" (state supplied vaccine).

For example, state-supplied measles, mumps and rubella virus vaccine (MMR) should be reported by billing $0.01 for 90707- SL. State-supplied vaccine products include both VFC and non-VFC vaccine products supplied by the State of Idaho to providers without charge.

Providers should report vaccine products that are not state-supplied by billing the usual and customary fee for the vaccine product and the appropriate CPT code with no modifier.

Providers may report immunization administration for both state-supplied and non-state-supplied vaccine products by billing the usual and customary fee and one of the appropriate immunization administration CPT codes (90471-90474) for each vaccine product administered. Immunization administration CPT codes should be billed without modifiers; modifier "SL" applies only to reporting state-supplied vaccine products.

Please contact us if you have questions regarding this legislation or our billing requirements.

3/10/2010