Best billing practices for immunizations

As National Immunization Month — and summer — wraps up. Here are a few reminders about how to bill for vaccinations, along with some news about HPV vaccine coverage. 

For the Kids: If your practice is in the state of Massachusetts, there is a program for children and adolescent vaccines through the age of 18 for both Commercial and Medicaid eligible patients. All Category A ACIP vaccines are covered. You can keep costs down for your practice and prevents claim denials by properly obtaining these vaccines from the MDPH for patients ages birth through eighteen. The Massachusetts Department of Public Health (MDPH) issues notices when there are shortages.

• Obtain these vaccines from the state for all child and adolescent patients – to find out more please follow this link from the MDPH, or take a look at their helpful FAQ.
• Affix modifier SL (state supplied) to the Vaccine CPT code for all claims submitted for vaccines procured from the DPH.
• We understand that sometimes the state runs out! If there is a vaccine shortage, you can bill for a privately purchased vaccine; documentation from the DPH should be produced to prevent claims denials.

For Adults: AllWays Health Partners covers and reimburses all recommended vaccines and immunizations that are FDA approved.

• NEW: AllWays Health Partners covers the HPV vaccine through age 45.
• We will reimburse a vaccine provided without an E/M service.
• We cover travel immunizations. Read our 5-minute guide to travel vaccines. 

More information

If you need to review our vaccination and immunization payment policy, you can find it here. Can't find what you're looking for? Reach out to our provider service team at providerservice@allwayshealth.org.