016.06.16 Ark. Code R. 009

Current through Register Vol. 49, No. 10, October, 2024

Rule 016.06.16-009 - Notice of Rule Making - Notice 005-15

Coverage of Vaccine Current Procedure Terminology (CPT^®) Procedure Codes 90620 and 90621

I.General Background Information on Vaccines

A. The Vaccines for Children (VFC) program was established to enable free access to childhood immunizations for Medicaid-eligible children under age nineteen.

The Arkansas Department of Health oversees the VFC program in Arkansas. To enroll in the VFC program and obtain the vaccines, providers may contact the Arkansas Department of Health at 1-800-462 -0599 or (501) 661-2000.

Arkansas Medicaid reimburses an administration fee for immunizations included in the VFC program. Providers billing for administration of immunizations should use the appropriate CPT^® code and required modifier(s).

All procedure codes under the VFC program may be billed electronically or on paper, using either the CMS-1500 claim form or the CMS-1450 claim form.

Medicaid policy regarding immunizations for adults remains unchanged by the VFC program.

B. The purpose of this notice of rulemaking is to inform Arkansas Medicaid providers of coverage of the CPT^® procedure codes 90620and 90621under the VFC program and the State Children's Health Insurance Program (SCHIP) per Centers for Disease Control and Prevention (CDC) designation as of June 24, 2015.

C. In addition, this notice is to inform providers that eligible, adult beneficiaries are covered by CPT^® procedure codes 90620and 90621vaccines per Centers for Disease Control and Prevention (CDC) recommendation as of June 24, 2015.

Any administration fee for adult vaccines is included in the reimbursement fee for the CPT^® procedure code.

II.Coverage

A. CPT^® procedure code, 90620, Meningococcal recombinant protein and outer membrane vesicle vaccine, serogroup B (MenB), 2 dose schedule, for intramuscular use. This vaccine is covered under the VFC and SCHIP programs for both sexes for ages 10 years through 18 years. This code is also covered for eligible beneficiaries of both sexes for ages 19 years through 25 years.

B. CPT^® procedure code, 90621, Meningococcal recombinant lipoprotein vaccine, serogroup B (MenB), 3 dose schedule, for intramuscular use. This vaccine is covered under the VFC and SCHIP programs for both sexes for ages 10 years through 18 years. This code is also covered for eligible beneficiaries of both sexes for ages 19 years through 25 years.

III. Billing Procedures for 90620 and 90621

Billing of 90620 and 90621may be submitted electronically or on paper claims.

Billing instructions are listed below for these procedure codes based on the date of service that the vaccine was administered and beneficiary eligibility:

Procedure Code	Required Modifiers	Age Restriction in Years	Special Instructions
90620	TJ	10y-18y	Covered for ARKids First-B providers under
90621	TJ	10y-18y 10y-18y	the VFC program from date-of-service 06/24/2015 through date of service 07/31/2015.
90620	SL*		Covered for ARKids First-B providers under
90621	SL*	10y-18y	the SCHIP vaccines program for dates of service on and after 08/01/2015.
90620	EP, TJ	10y-18y	Covered for ARKids First-A providers under
90621	EP, TJ	10y-18y	the VFC program on and after dates of service 06/24/2015.
90620	No	19y through 25y	Covered for eligible beneficiaries for dates of service on and after 06/24/2015
90621	No	19y through 25y	Covered for eligible beneficiaries for dates of service on and after 06/24/2015

*For dates of service on and after August 1, 2015, ARKids First-B beneficiaries are not eligible for the Vaccines for Children (VFC) program; however, vaccines can be obtained to administer to ARKids First-B beneficiaries who are under the age of 19 by contacting the Arkansas Department of Health at 1-800-462 -0599 or (501) 661-2000 and indicating the need to order ARKids-B SCHIP vaccines.

Only a vaccine injection administration fee is reimbursed. When filing claims for administering vaccines for ARKids First-B beneficiaries, providers must use the CPT^® procedure code for the vaccine administered and the required modifier SL only for either electronic or paper claims. Providers must bill claims for ARKids First-B beneficiaries using the CMS-1500 claim format.

If you have questions regarding this notice, please contact the Hewlett Packard Enterprise Provider Assistance Center at 1-800-457 -4454 (Toll-Free) within Arkansas or locally and Out-of-State at (501) 376-2211.

If you need this material in an alternative format, such as large print, please contact the Program Development and Quality Assurance Unit at (501) 320-6429.

Arkansas Medicaid provider manuals (including update transmittals), official notices, notices of rule making and remittance advice (RA) messages are available for download from the Arkansas Medicaid website: www.medicaid.state.ar.us.

Thank you for your participation in the Arkansas Medicaid Program.

016.06.16 Ark. Code R. 009

4/1/2016