Idaho Immunization Assessment Fund Update
Summary: The Idaho Immunization Program (IIP) provides childhood vaccine products for all children residing in Idaho, including both Vaccines for Children (VFC) vaccines for children eligible for the federal VFC program and non-VFC vaccines for children with private insurance coverage who are not eligible for VFC vaccines. Currently, the VFC vaccines include the human papilloma vaccine (HPV) for males and females, and non-VFC vaccines do not include HPV. Effective July 1, 2011, non-VFC vaccines will include HPV for females, but not for males.
Detailed Information: The Idaho Immunization Program (IIP) located in the Department of Health and Welfare's Division of Public Health, continues to provide childhood vaccine products for all children residing in Idaho, including those with private insurance coverage who are not eligible for federal Vaccines for Children (VFC) program vaccines. Since July 1, 2010, non-VFC vaccine products for insured children have been purchased with funds collected from statutory mandatory assessments from insurers. Effective July 1, 2011, additional non-VFC vaccines will be provided by the IIP.
Currently, the VFC vaccines include the human papilloma vaccine (HPV) for males and females, and non-VFC vaccines do not include HPV. Effective July 1, 2011, non-VFC vaccines will include HPV for females, but not for males. VFC vaccines include HPV for males but non-VFC vaccines will not include HPV for males because the Advisory Committee for Immunization Practices (ACIP) currently does not specifically recommend HPV for males, but instead states that HPV 'may be administered' to males (a 'permissive' statement).
Providers who previously have ordered non-VFC influenza vaccine from the IIP may continue to order non-VFC influenza vaccine from the IIP for the 2011-12 season. Providers may not bill for state-supplied influenza vaccine product. Providers may administer and bill for privately purchased influenza vaccine product during the 2011-12 influenza season. The IIP intends to encourage most primary care providers to order non-VFC influenza vaccine from the IIP beginning with the 2012-13 season.
For up-to-date information regarding state-supplied vaccine products (both VFC and non-VFC), including procedures for obtaining these state-supplied vaccine products, click on the 'Healthcare Providers' link at http://www.immunizeidaho.org.
For vaccine products supplied by the IIP, the following guidelines must be followed:
- 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 both 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.
- Report all state-supplied (both VFC and non-VFC) vaccine products administered using the appropriate Current Procedural Terminology (CPT®) code within the code range of CPT 90476-90749 Vaccination Products appended with Modifier -SL State supplied vaccine.
- It is illegal for a provider to bill any amount in excess of $0.01 for state-supplied vaccine. Carriers pay for non-VFC vaccines through assessments, and will not pay providers for these state-supplied vaccine products.
For vaccine products NOT supplied by the IIP, the following guidelines must be followed:
- Report vaccine products that are not state-supplied using the appropriate code within CPT code range 90476-90749 Vaccination Products with no modifier.
- Bill the usual and customary fee or the applicable insurance carrier's fee schedule amount for the vaccine product.
- Report immunization administration for either state-supplied or non-state-supplied vaccine products by billing the usual and customary fee and the appropriate codes without modifers within CPT code range 90471-90474 Injections and Other Routes of Administration Without Physician Counseling for each vaccine/toxoid administered.
Please contact the carrier if you have questions regarding their billing requirements.
