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Billing and Reimbursement

Ask the Experts: Topics

Billing and Reimbursement

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Administering Vaccines
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Billing and Reimbursement
What is the Vaccines for Children (VFC) program?
VFC is a program designed to reduce or eliminate vaccine cost as a barrier to childhood vaccination. The program purchases vaccines from manufacturers at federal contract prices and provides them at no cost to participating public and private healthcare providers for use in children through age 18 years who are eligible for Medicaid, are uninsured, or are American Indian or Native American. Children whose health insurance benefit plan does not cover a particular VFC vaccine are also able to receive VFC vaccine at a Federally Qualified Health Center (FQHC) or Rural Health Clinic (RHC). If you are interested in becoming a VFC provider, you should contact your state immunization program. For more information on the VFC program in general, go to the CDC's website at www.cdc.gov/vaccines/programs/vfc/index.html.
If a child isn't covered by health insurance but the parent plans to get insurance, is the child eligible for VFC vaccine?
If the child has no health insurance on the day he or she presents at a medical practice or health department for immunization, the child is VFC eligible because he or she is uninsured. A child must be screened for VFC eligibility at each visit, even though the eligibility form needs to be updated only when the child's eligibility status changes.
Do I need to verify my patient's residency status before using VFC vaccine?
No. The CDC states that the only criteria are age (age 18 years or younger) and the four eligibility criteria listed previously. No other factors (for example, residency status) can be considered when screening for eligibility requirements for the VFC program.
What is the Current Procedural Terminology (CPT) code for HPV vaccine?
The CPT codes for HPV vaccines, used for billing purposes, are 90649 for Gardasil (Merck) and 90650 for Cervarix (GSK).
 
This page was reviewed on May 1, 2014
 
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This website is supported in part by a cooperative agreement from the National Center for Immunization and Respiratory Diseases (Grant No. 6NH23IP22550) at the Centers for Disease Control and Prevention (CDC) in Atlanta, GA. The website content is the sole responsibility of IAC and does not necessarily represent the official views of CDC.