Immunizations & Vaccinations
Revised: 01-15-2016
Overview
This section includes MHCP vaccination coverage and billing policy for children and adults. MHCP coordinates with the
Minnesota Department of Health’s (MDH) Minnesota Vaccine For Children (MnVFC) program to provide pediatric
vaccines at no cost to providers. For more information about free vaccine availability from MDH through MnVFC program,
please visit: http://www.health.state.mn.us/divs/idepc/immunize/index.html.
The MDH MnVFC Program is for MHCP recipients ages 0 through 18.
As of Jan. 1, 2014, the MDH no longer provides free vaccines for adults age 19 or older. However, MHCP will continue to
cover adult flu vaccines and other recommended vaccinations for adults. Providers must use their private stock to bill
MHCP for all covered adult vaccines.
Eligible Providers
The following MHCP-enrolled health care providers may bill for vaccines and toxoids and administering vaccines and
toxoids:
 Certified family nurse practitioners
 Certified pediatric nurse practitioners
 Certified nurse-midwives
 Child and Teen Checkups providers
 Clinics
 Convenience clinics
 Home health agencies
 Outpatient and inpatient hospitals
 Pharmacies
 Physicians
 Public health clinics
 Public health nursing clinic providers
Minnesota Statutes (256B.0625, subd. 39) requires all MHCP enrolled providers who administer pediatric vaccines to
enroll in the MCH MnVFC program.
Minnesota Statutes (151.01, subd. 27) allows pharmacies to bill for flu vaccines administered by pharmacists to children
and all other vaccines to adults. Effective July 1, 2015, pharmacist can bill for flu vaccines administered to children ages
six and older and all other vaccines to people who are age 13 or older under standing orders from a licensed physician or
by written protocol with a physician provided that the pharmacist meets the following:
 Is trained in a program approved by the American Council of Pharmaceutical Education for the administration of
vaccinations or graduated from a college of pharmacy in 2001 or after
 Reports the administration of the vaccinations to the Minnesota Immunization Information Connection (MIIC),
 Uses the MIIC to assess the immunization status of a person before administering vaccines, except when
administering influenza vaccines to a person age nine or older
Minnesota Statutes (150A.055) allows dentists who meet all of the following to administer influenza vaccines to patients
aged 19 and older:
 Are trained in or have successfully completed a program approved by the Minnesota Board of Dentistry specifically for
the administration of immunizations and must submit attestation on the Immunization Delivery for Dentists Applicant
Assurance Statement (DHS-7121) (PDF)
 Have immediate access to emergency response equipment, including but not limited to oxygen administration
equipment, epinephrine, and other allergic reaction response equipment
 Reports the administration of the immunization to Minnesota Immunization Information Connection or the patient’s
primary physician or clinic
Eligible Recipients
Recipients enrolled in the following MHCP programs are eligible for vaccination services:
BB MinnesotaCare Plus One
FF
MinnesotaCare Basic Plus
MinnesotaCare Basic Plus Two
IM
JJ
LL
MA
NM
QM
RM
Institution for Mental Disease
MinnesotaCare Basic Plus
MinnesotaCare Basic Plus Two
MinnesotaCare Expanded
Medical Assistance
State-funded Medical Assistance
Qualified Medicare Beneficiary
Refugee
Recipients enrolled in the following programs are not eligible for MHCP vaccination services:
AC Alternative Care Program
HH HIV/AIDS
EH Emergency Medical Assistance
FP MN Family Planning Program
Covered Services
MHCP covers the following services:
 Vaccines (See Quick Reference Guide at the end of this section)
 Toxoids (See Quick Reference Guide at the end of this section)
 Administering vaccines and toxoids, including those available through the MDH Vaccine Program
 Office visits associated with administering vaccinations when the appointment is not solely to administer vaccinations
Noncovered Services
MHCP does not cover the following services:
 Reimbursement for vaccines available from the MDH MnVFC Program that are not obtained and used
 Reimbursement for vaccines is not available under IEP services
Claim lines deny when billing the following:
 A vaccine code is billed without a vaccine administration code,
 A vaccine administration code is billed without a vaccine code.
Administering Vaccines – Billing and Payments
Refer to the following billing and payment information:
 Bill office visits associated with administering vaccinations when the visit is not solely to administer vaccines.
 Qualifying ACA enhanced primary care providers who administer MnVCF vaccines to children under age 18 will be
paid the enhanced administration rate for calendar year 2014-2015. Refer to the Primary Care and VFC Incentive
Program for more information.
 Minnesota caps administration charges for vaccine obtained through the MDH MnVFC program at $21.22.
 Vaccine administration payment is the lower of:
 submitted charge; or
 the appropriate rate from the chart below
2015 MDH Vaccine
2015 Rates for Vaccines NOT
Vaccine Administration Code
Programs Rates
Available from MDH
90460* (first or only component of each vaccine/
$21.22
$19.82
toxoid)
90461 (each additional vaccine/ toxoid component)
$ 0.00
$ 0.00
90471 (1 single or combination vaccine/toxoid)
$21.22
$19.82
90472 (each additional vaccine, single or
$10.61
$9.49
combination vaccine/toxoid)
90473 (intranasal or oral administration, single or
$21.22
$19.82
combination vaccine/toxoid)
90474 (each additional vaccine, single or
$10.61
$9.49
combination vaccine/toxoid)
G0008 flu (initial)
$21.22
$19.82
G0009 PPV (initial)
$21.22
$19.82
G0010 Hep B (initial)
$21.22
$19.82
*Code 90460 (with counseling) is considered the initial administration code when billed with other non-counseling vaccine
administration codes.
**According to the CDC, reimbursement for administering VFC vaccine is per injection, not per component
Vaccines obtained from the MDH MnVFC Program
Refer to the following when billing for MDH MnVFC vaccines:
 Use the 837P or 837I MN–ITS transaction
 Enter the appropriate vaccine code
 Enter modifier SL with the vaccine code
 Enter $0 for the charge
 Enter the appropriate vaccine administration code on the same claim
 Enter the usual and customary charge for administering the vaccine, not to exceed $21.22 per vaccine
MHCP does not reimburse for vaccines obtained at no cost from MDH MnVFC Program.
Vaccines NOT obtained from the MDH MnVFC Program
MHCP reimburses for children’s vaccines only when the vaccines are not available through the MDH MnVFC Program.
Bill for children’s vaccines that are not available from the MDH MnVFC program according to
the following:





Use the 837P or 837I MN–ITS transaction
Enter the appropriate vaccine code and vaccine administration code on the same claim
Do not enter modifier SL with the vaccine code
Enter the usual and customary vaccine charge
Enter the usual and customary charge for administering the vaccine
Payments for vaccines NOT obtained from the MDH MnVFC program are based on the lowest of:
 Submitted charge,
 Medicare’s Average Sale Price (ASP) plus 6%, or
 The wholesale acquisition cost if Medicare has not established an ASP
Seasonal Influenza Vaccines
Seasonal Influenza Vaccines 2015-2016 Flu Season
Availability of annual seasonal flu vaccine and distribution timing vary. Contact MDH for information about flu season and
availability and distribution of flu vaccine or refer to www.health.state.mn.us/divs/idepc/immunize/hcp/index.html.
Providers must obtain pediatric flu vaccines from the MDH MnVFC Vaccine Program when available.
Seasonal Flu Vaccines for Ages 18 and Younger Fee-for-service Enrollees
 Enter $0 under charge for MnVFC vaccine
 Enter modifier SL for MnVFC vaccine
 Use administration codes 90460-90461 or 90471-90474 or G0008 as appropriate
Code
90655
90656
90657
90658
90672
90685
90686
90687
90688
Q2035
Q2037
Ages
6-35 months
3 years & older
6-35 months
3 years & older
2 years to 18
years
6-35 months
3 years & older
6-35 months
3 years & older
3 years & older
3 years & older
Seasonal Flu Vaccines for Ages 19 and Older
 Use privately purchased seasonal flu vaccine
 Enter appropriate CPT code Enter appropriate administration code
 Do not enter modifier SL with the vaccine code
 Enter usual and customary charge
Code
90630
90654
90656
90658
90661
90662
90672
90673
90686
90688
Q2033
(Medicare)
Q2034
(Medicare)
Q2035
(Medicare)
Q2036
(Medicare)
Q2037
(Medicare)
Q2038
(Medicare)
Ages
19 through 64 years
19 through 64
19 years & older
19 years & older
19 years & older
65 years and older
19 through 49 years
19 through 49 years
19 years & older
19 years & older
19 years through 49
19 years & older
19 years & older
19 years & older
19 years & older
19 years & older
MHCP Vaccines and Toxoids Quick Reference
Refer to the Centers for Disease Control and Prevention VFC Vaccine Resolutions for more information.
Code
Description
Age Range
90620
90621
90630
90632
90633
90636
90644
90647
90648
90649
90650
90651
90654
90655
90656
90657
90658
90661
90662
Q2033
Q2034
Q2035
Q2036
Q2037
Q2038
Q2039
90669
90670
90672
Meningococcal -Bexsero
Meningococcal -Trumenba
Influenza
Hepatitis A
Hepatitis A
HepA-HepB
Hib-Mency
Hib,PRP-OMP conjugate
Hib, PRP-T conjugate
HPV
HPV
HPV
Influenza
Influenza
Influenza
Influenza
Influenza (FluLaval IIV3)
Influenza (Flucelvax (ccllv3)
Influenza
Influenza
Influenza
Influenza (Afluria)
Influenza (Flulaval)
Influenza (Fluvirin)
Influenza (Fluzone)
Influenza (NOS flu)
Pneumococcal
PCV 13/Prevnar 13
Influenza (FluMist)
10 years through 25 years
10 years through 25 years
19 through 64 years
19 years & older
18 years & younger
19 years & older
6 -18 months
2 months – 5 years
2 months – 5 years
Females & males 9 through 28 years
Females 9 through 28 years
Females & males 9 through 28 years
19 through 64 years
6-35 months
3 years & older
6-35 months
3 years & older
19 years & older
65 years & older
19 years through 49 years
19 years and older
3 years & older
19 years & older
3 years & older
3 years & older
3 years & older
2-59 months
6 weeks & older
2 years though 49 years
Available from MDH
MnVFC Program?
Yes
Yes
No
No
Yes
No
Yes
Yes
Yes
Yes
Yes
Yes
No
Yes
Yes
Yes
Yes
No
No
No
No
No
No
No
Yes
Yes
Yes
Yes
Yes
90673
90680
90681
90685
90686
90687
90688
90696
90698
90700
90702
90707
90710
90713
90714
90715
90715
90716
90723
90732
90734
90736
90740
90744
90746
90747
90748
Influenza (Flublok)
Rotavirus
Rotavirus
Influenza (Fluzone)
Influenza (Fluzone
Influenza (Fluzone)
Influenza (Fluzone)
DTap-IPV
DTaP-HIB-IPV
DTaP
DT
MMR
MMRV
IPV
Td
Tdap (Adacel)
Tdap (Boostrix)
Varicella virus
DtaPHepB-IPV
PPSV23 (Pneumococcal
polysaccharide)
Meningococcal
Zoster
Hepatitis B
Hepatitis B
Hepatitis B
Hepatitis B
HepB-Hib
19 years through 49 years
6 weeks-8 months
6 weeks-8 months
6-35 months
3 years & older
6-35 months
3 years & older
4 through 6 years
4 years & younger
7 years & younger
7 years & younger
12 months & older
12 years & younger
6 weeks and older
7 years & older
11 – 64 years
10 years & older
12 months & older
6 years & younger
2 years & older
No
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
2 months & older
50 & older
2 months and older
18 years & younger
19 years & older
2 months and older
2 months & older
Yes
No
Yes
Yes
No
Yes
Yes
MHCP Quick Reference for Vaccine and Toxoid Administration Codes
Enter the appropriate administration code with each single or combination vaccine or toxoid.
Code
Use to report
Administration
MHCP Limitations
administering:
Route
90460 Single or 1st vaccine/toxoid
Any
 18 years & younger
component of combination
 Physician or other health care professional counseling
vaccine
 Report multiple units on same line
 First/only vaccine/toxoid component
 Use with 90461, 90472 or 90474
90461 Each additional component of Any
 Use only with 90460
combination vaccine
 Report multiple units on same line
 Use to report each additional vaccine/toxoid
component
90471 1 vaccine (single or
Percutaneous
Do not use with 90473
combination)
Intradermal
Subcutaneous
Intramuscular
90472 Each additional vaccine
Percutaneous
Use with 90460, 90471 or 90473; list separately (not on
Intradermal
same line)
Subcutaneous
Intramuscular
90473 1 vaccine (single or
Oral
Do not use with 90471
combination)
Intranasal
90474 Each additional vaccine
Oral
Use with 90460, 90471 or 90473; list separately (not on
(single or combination)
Intranasal
same line)
G0008 Single or 1st vaccine/toxoid
Any
 Billed with vaccine codes: 90655, 90656, 90657,
component of combination
90658, 90672, 90673, 90685,90686, 90687,
vaccine
90688,Q2033, Q2034, Q2035, Q2036, Q2037, Q2038,
Q2039
 Use with 90472 or 90474 list separately (not on same
line)
G0009
G0010
Single or 1st vaccine/toxoid
component of combination
vaccine
Single or 1st vaccine/toxoid
component of combination
vaccine
Any


Any


Billed with vaccine codes: 90669, 90670, 90732
Use with 90472 or 90474 list separately (not on same
line)
Billed with vaccine codes: 90740, 90744, 90746, 90747
Use with 90472 or 90474 list separately (not on same
line)
Legal References
Minnesota Statutes 256B.0625, subd.39 Covered Services-Childhood Immunizations
Minnesota Statutes (151.01, subd. 27) allows pharmacies to administer flu vaccines to children 10 years and older and all
other vaccine to 18 years and older
Minnesota Statutes (150A.055) allows dentists to administer flu vaccines to adults 19 years of age and older