Indiana Medicaid increases VFC vaccine administration rate, eliminates reimbursement for non-VFC vaccines
Effective Jan. 1, the Indiana Health Coverage Programs (IHCP) reimbursement for administering Vaccines for Children (VFC) will increase to $15 per dose. Providers will continue to bill the appropriate CPT administration codes 90471-90474 with the SL modifier. For dates of service on or after Jan. 1, 2020, the VFC administration codes will reimburse a maximum of $15 or the submitted charge, whichever is lower.

Also effective Jan. 1, for children younger than 19, if a vaccine is available through the VFC program, the IHCP will no longer reimburse the use of a non-VFC vaccine (private stock vaccine). This change applies to members in fee-for-service (FFS) and managed care delivery systems. Physicians and other medical care providers that are not currently enrolled in the VFC program are encouraged to enroll, to ensure members do not experience disruption in care.

See more information and examples of how these changes would apply in specific cases >>