VFC vaccine coding and reimbursement
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Guidance on coding and reimbursement for Vaccines for Children (VFC) program immunizations for AHCCCS members; affects providers billing vaccine and vaccine administration claims in Arizona.
CPT code 90461 is closed and any claim with 90461 will be denied.
When VFC stock vaccine is administered, both the vaccine code and the administration code must include the SL modifier.
Administration fees are per vaccine administration (per injection), not per antigen; multiple injections are paid separately when reported with CPT 90460 and SL.
Only CPT code 90460 with SL modifier is billable for VFC immunization administration; claims must include toxoid, rendering provider, and use correct form fields.
VFC Billing and Payment Criteria
VFC billing and payment criteria
Billing and payment rules for VFC vaccines administered to members under 18
Administration Codes and Payment Basis
Required Billing Actions and Denial Risks
Use 90460 + SL for VFC administration; 90461 is closed
Report vaccine administration for VFC vaccines using CPT code 90460 and append the SL modifier to the administration claim; do not submit CPT 90461 because it is closed and any claim containing 90461 will be denied effective 10/1/24.
- Apply SL modifier to both the vaccine code and the administration code when VFC stock is used.
- Claims with 90461 will be denied regardless of modifier; only 90460 with SL is billable for VFC administration.
- When filing CMS-1500 (Box 24/19/17) or UB-50/UB-04, include 90460 with SL, the toxoid administered, and the rendering provider.
- Do not add SL for vaccines administered to members over 18 or for non‑VFC pediatric vaccines.
Modifier and Term Definitions
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