Posted in Insurance, Payers and CPT reinbursement, Training

Flu vaccine and provider reimbursement for Medicaid, MC and Child Health Plus patients (for NY State)

The flu season is upon us and many providers would like to bill for administering the flu vaccine. Unfortunately, not all providers will get reimbursed.

Once the provider administers the flu vaccine and starts to enter it into the EHR (ex. Practice Fusion), there is a VFC qualifier that the provider needs to answer.

So, now let’s look at what VFC is?

Vaccines for Children Program: federally funded program that provides vaccines at no cost for children who might not be able to pay for a vaccine.

Who qualifies: Any child under the 18 years of age, underinsured, and uninsured patients.  If you see Medicaid, Managed Care or Child Health Plus patients, then those would be the ones that qualify for the VFC. If you see any of those patients, provider should check the box and say YES in the EHR (or select YES, in Practice Fusion)

What does this mean for the providers?

If you are a provider that is located in Public health Clinic, Federally Qualified Health Center, or Rural Health Clinic and are enrolled in the VFC program; you qualify to receive the a reimbursement max and receive the vaccine free of charge from the federal government. The following are the 2017 rates:

– Medicaid Fee-for-Service- $17.85

-Medicaid Managed care- as per contractual agreement

-CHP-as per contractual agreement

– Uninsured $25.10

-Underinsured- $25.10

-American Indian/Alaskan Native- $25.10

However, If you are independent provider that is not enrolled into the VFC program (ex. specialist); bought your own vaccine – you will be reimbursed for administration of the vaccine ONLY for adults. No less than 2017-2018 CMS rates that can be found on their website: Drugs/McrPartBDrugAvgSalesPrice/VaccinesPricing.html



My name is Kate Patskovska, CPB. I am an Independent Medical Biller CPB (AAPC) and an owner of KR2 Medical Billing. KR2 Medical Billing is a full service Consulting/Medical Billing Business that is dedicated to educating, consulting, and overall improving the "financial health" of your medical practice.

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