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Attention providers:
What is changing?
The Health Care Authority (HCA) is updating the billing guidelines for the Vaccines for Children (VFC) program as detailed below:
Effective for dates of service on or before June 30, 2024
The VFC administration rate is enhanced to cover administration and administrative costs. The current EPSDT Well-Child Program Billing Guide instructs providers to not bill administration codes with VFC vaccines.
Effective for dates of service on and after July 1, 2024
HCA will reduce the administrative fee and will pay administration codes at Medicare rates. The EPSDT Well-Child Program Billing Guide will allow providers to bill the administration codes with VFC vaccines. This is a budget neutral change.
Note: HCA allows the administration of COVID-19 and respiratory syncytial virus (RSV) vaccines, under the VFC program, when billed with the appropriate administrative procedure codes.
Billing Guide and Fee Schedule
HCA will revise the EPSDT Well-Child Program Billing Guide and the Enhanced Pediatric, Physician-Related/Professional Services, and Professional Administered Drug Fee Schedules to reflect this change and publish the revised documents by July 1, 2024. See HCA’s Provider billing guides and fee schedules, under Early and periodic screening, diagnosis and treatment (EPSDT).
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