Modifier SL (State‑supplied vaccine) reimbursement
Defines when the Plan recognizes and reimburses services billed with modifier SL to indicate a vaccine obtained at no cost to the provider; applies to professional claims for Premera Blue Cross and affiliated lines of business and products.
No material clinical or coverage changes in this revision.
Coverage rules for Modifier SL
Modifier SL coverage rules
Coverage stance for vaccine products and administration when modifier SL is used.
ALL of the following
ALL of the following
- Vaccine product codes billed with modifier SL will not be reimbursed because SL indicates the vaccine was provided at no cost to the provider.
ALL of the following
- Procedure codes representing the administration of vaccines will be reimbursed when submitted separately.
- Modifier SL is not appropriate to be appended to vaccine administration codes and will be denied as incorrect coding.
Exception
- Vaccines billed by the Washington State Vaccine Association are allowed/reimbursed when appended with modifier SL.
- Exceptions to the policy may also be made where a provider contract dictates otherwise.
ALL of the following
ALL of the following
- Applies to professional claims for Premera Blue Cross and affiliated lines of business and products.
Relevant procedure codes and billing notes
| 90460 | Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; first or only component of each vaccine or toxoid administered |
| 90461 | Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; each additional vaccine or toxoid component administered (List separately in addition to code for primary procedure) |
| 90471 | Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 vaccine (single or combination vaccine/toxoid) |
| 90472 | Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); each additional vaccine (single or combination vaccine/toxoid) (List separately in addition to code for primary procedure) |
| 90473 | Immunization administration by intranasal or oral route; 1 vaccine (single or combination vaccine/toxoid) |
| 90474 | Immunization administration by intranasal or oral route; each additional vaccine (single or combination vaccine/toxoid) (List separately in addition to code for primary procedure) |
| 90480 | Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, single dose |
Billing actions and provider instructions
Do not append modifier SL to vaccine administration codes
Do not append modifier SL to vaccine administration codes. Modifier SL indicates the vaccine was obtained at no cost to the provider and any vaccine product billed with SL will not be reimbursed; administration procedure codes will be reimbursed. Modifier SL appended to an administration code is not appropriate and will be denied as incorrect coding.
- Modifier SL denotes a no‑cost vaccine; vaccine product codes billed with SL will not be paid.
- Procedure codes representing vaccine administration will be reimbursed when billed separately.
- Appending SL to administration codes is inappropriate and will result in denial for incorrect coding.
Key definitions
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.