Arkansas Administrative Code
Agency 016 - DEPARTMENT OF HUMAN SERVICES
Division 06 - Medical Services
Rule 016.06.06-023 - Official Notice DMS-2006-A-3, DMS-2006-AR-2, DMS-2006-G-2, DMS-2006-II-3, DMS-2006-L-3, DMS-2006-KK-3, DMS-2006-R-3, DMS-2006-OO-2 - Vaccines Available in the Vaccines for Children (VFC) Program
Current through Register Vol. 49, No. 9, September, 2024
Vaccines Available in the Vaccines for Children (VFC) Program
The purpose of this Official Notice is to inform providers of vaccines recently available through the VFC program and to furnish billing instructions. The effective dates for VFC reimbursement for the administration of the vaccines identified in this notice are based on the availability of vaccines through VFC. Coverage and billing for ages 19 years and above are unchanged.
I. Hepatitis A vaccine, pediatric/adolescent dosage - 2 dose schedule, for intramuscular use, 90633 is now available through the VFC Program. Effective for dates of service on and after March 1, 2006, Medicaid will only reimburse providers for administering the vaccine. Reimbursement will be retroactive to March 1, 2006.
For dates of service on or after March 1, 2006, claims must be filed using the following procedure code with modifiers and type of service. Claims for the administration of the Hepatitis A 2-dose vaccine may be filed upon receipt of this Official Notice.
|
Category |
Procedure Code |
Electronic Claims Modifiers |
Paper Claims Modifiers and Type of Service |
|
Regular Medicaid (Includes ARKids A) |
90633 |
TJ, EP |
TJ, EP, type of service 6 |
|
ARKids First-B |
90633 |
TJ |
TJ, type of service 1 |
II. Hepatitis A vaccine pediatric/adolescent dosage - 3-dose schedule for intramuscular use, 90634, is now available through the VFC Program. Effective for dates of service on and after March 1, 2006, Medicaid will reimburse providers only for administering the vaccine. Reimbursement will be retroactive to March 1, 2006.
For dates of service on and after March 1, 2006, claims must be filed using the following procedure code and applicable modifiers. Claims for the administration of Hepatitis A vaccine 3-dose may be filed upon receipt of this Official Notice.
|
Category |
Procedure Code |
Electronic Claims Modifiers |
Paper Claims Modifiers and Type of Service |
|
Regular Medicaid (Includes ARKids A) |
90634 |
TJ, EP |
TJ, EP, type of service 6 |
|
ARKids First-B |
90634 |
TJ |
TJ, type of service 1 |
III. Measles, Mumps, Rubella and Varicella vaccine (MMRV), live for subcutaneous use, 90710, is now available through the Vaccines for Children (VFC) Program. Effective for dates of service on and after March 1, 2006, Medicaid will reimburse providers only for administering the vaccine. Reimbursement will be retroactive to March 1, 2006.
For dates of service on and after March 1, 2006, claims must be filed using the following procedure code and applicable modifiers. Claims for Measles, Mumps, Rubella and Varicella vaccine (MMRV) may be filed upon receipt of this Official Notice.
|
Category |
Procedure Code |
Electronic Claims Modifiers |
Paper Claims Modifiers and Type of Service |
|
Regular Medicaid (Includes ARKids A) |
90710 |
TJ, EP |
TJ, EP, type of service 6 |
|
ARKids First-B |
90710 |
TJ |
TJ, type of service 1 |
IV. Tetanus, Diphtheria, Toxoids and Acellular Pertussis vaccine (Tdap) for use in individuals 7 years or older, for intramuscular use, 90715, is now available through the Vaccines for Children (VFC) Program. Effective for dates of service on and after March 1, 2006, Medicaid will reimburse providers only for administering the vaccine. Reimbursement will be retroactive to March 1, 2006.
For dates of service on and after March 1, 2006, claims must be filed using the following procedure code and applicable modifiers. Claims for the administration of Tetanus, Diphtheria, Toxoids and Acellular Pertussis vaccine (Tdap) may be filed upon receipt of this Official Notice.
|
Category |
Procedure Code |
Electronic Claims Modifiers |
Paper Claims Modifiers and Type of Service |
|
Regular Medicaid (Includes ARKids A) |
90715 |
TJ, EP |
TJ, EP, type of service 6 |
|
ARKids B |
90715 |
TJ |
TJ, type of service 1 |
Thank you for your participation in the Arkansas Medicaid Program.
If you need this material in an alternative format, such as large print, please contact our Americans with Disabilities Act Coordinator at (501) 682-6789 and 1-877-708 -8191. Both telephone numbers are voice and TDD.
If you have questions regarding this notice, please contact the EDS Provider Assistance Center at In-State WATS 1-800-457 -4454, or locally and Out-of-State at (501) 376-2211.
Arkansas Medicaid provider manuals, (including update transmittals), official notices and remittance advice (RA) messages are available for downloading from the Arkansas Medicaid website: www.medicaid.state.ar.us
Roy Jeffus, Director
