The Washington Health Care Authority recently sent a Provider Alert to clarify a billing change for administration of vaccines obtained through the Vaccines for Children (VFC) program. The change was effective for services on or after July 1, 2024. Providers should bill for the vaccine administration and the vaccine itself as separate charges. Administration of the vaccine should be billed using the appropriate CPT code and the vaccine with the appropriate vaccine procedure code and modifier SL. A copy of the alert with a billing example is here.
This change was made to ensure uniformity and consistency across billing practices for VFC and non-VFC vaccines. This change is generally budget neutral to providers, compared to the previous billing policy. HCA has revised the EPSDT Well-Child Program Billing Guide, the Enhanced Pediatric, Physician-Related/Professional Services, and Professional Administered Drug Fee Schedules to reflect the changes. (Andrew Busz, andrewb@wsha.org).
