CurrentPremera BluecrossPolicy N/A

Modifier SL (State‑supplied vaccine) reimbursement

Defines when Premera Blue Cross recognizes and reimburses services billed with modifier SL on professional claims and which vaccine/admin codes are affected; applies across Premera and affiliated lines of business (including Alaska and Washington programs where noted).

Policy Summary

PayerPremera Bluecross

PolicyModifier SL (State‑supplied vaccine) reimbursement

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateSep 8, 2025

Key ActionDo not append modifier SL to vaccine administration codes; vaccine product codes billed with modifier SL will not be reimbursed.

SourceLink

Product not reimbursedModifier SL stance

ReimbursedAdministration codes

WSVA allowedWA exception

90480COVID admin code

Professional (CMS-1500)Claim scope

Modifier SL Coverage Rules

Modifier SL coverage criteria

Coverage rules for professional claims with modifier SL:

ALL of the following

A vaccine product/procedure code billed with modifier SL indicates the vaccine was obtained at no cost to the provider and will not be reimbursed by the Plan.
Procedure codes representing the administration of vaccines will be reimbursed even if the vaccine product is billed with modifier SL.
Modifier SL is not appropriate to be appended to a vaccine administration code and will be denied as incorrect coding.
Per CPT guidance, administration procedure codes 90460 and 90461 include face-to-face counseling; administration procedure codes 90471-90474 do not include face-to-face counseling.

Policy Summary

PayerPremera Bluecross

PolicyModifier SL (State‑supplied vaccine) reimbursement

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateSep 8, 2025

Key ActionDo not append modifier SL to vaccine administration codes; vaccine product codes billed with modifier SL will not be reimbursed.

SourceLink

On This Page

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.

Vaccine Administration Codes and Guidance

Vaccine administration codes and guidanceCPTCovered

90460	Immunization administration through 18 years of age via any route of administration, with counseling; first or only component
90461	Immunization administration through 18 years of age via any route of administration, with counseling; each additional component
90471	Immunization administration; 1 vaccine (includes percutaneous, intradermal, subcutaneous, or intramuscular injections)
90472	Immunization administration; each additional vaccine (List separately in addition to code for primary procedure)
90473	Immunization administration by intranasal or oral route; 1 vaccine
90474	Immunization administration by intranasal or oral route; each additional vaccine (List separately in addition to code for primary procedure)
90480	Immunization administration by intramuscular injection of SARS-CoV-2 (COVID-19) vaccine, single dose (report for administration of 91304, 91318-91322)

Billing and Modifier Use — Provider Guidance

Billing Rule

Billing: Do not append SL to administration codes; product codes with SL not reimbursed

Do not append modifier SL to vaccine administration procedure codes; modifier SL indicates the vaccine was obtained at no cost and vaccine product codes billed with modifier SL will not be reimbursed. Administration procedure codes (e.g., 90460-90461, 90471-90474, 90480) will be reimbursed, but appending SL to administration codes is incorrect coding and will be denied. Exception: vaccines billed by the Washington State Vaccine Association are allowed/reimbursed with modifier SL.

Modifier SL indicates the vaccine was obtained at no cost to the provider; vaccine product codes billed with SL will not be reimbursed. [[cited]]
Vaccine administration procedure codes (90460-90461, 90471-90474, 90480) will be reimbursed; do not append modifier SL to these administration codes (it will be denied as incorrect coding). [[cited]]
Exception: Vaccines billed by the Washington State Vaccine Association are allowed/reimbursed when appended with modifier SL. [[cited]]

Modifier Definitions

inv-04: Modifier SL — definition and short descriptor

TermModifier SL

DefinitionIndicates the vaccine was obtained at no cost to the provider; a vaccine product code billed with modifier SL will not be reimbursed by the Plan.

ApplicabilityApplies to professional claims (CMS-1500 / 837P) across Premera Blue Cross, Premera BCBS of Alaska, LifeWise Health Plan of Washington, LifeWise Assurance Company, and Premera Blue Cross HMO lines of business.

Use with administration codesModifier SL is not appropriate to append to vaccine administration procedure codes and will be denied as incorrect coding.

Related coding guidancePer CPT guidance, administration codes 90460 and 90461 include face-to-face counseling; 90471-90474 do not include counseling. SARS‑CoV‑2 vaccine procedure codes (91304, 91318-91322) are reported with administration code 90480, not 90460-90474.