Arkansas Administrative Code
Agency 016 - DEPARTMENT OF HUMAN SERVICES
Division 06 - Medical Services
Rule 016.06.06-055 - Vaccines Available in the Vaccines for Children (VFC) Program

I. Effective for dates of service on and after July 10, 2006, a new vaccine, "rotavirus vaccine, pentavalent, 3 dose schedule, live, for oral use" (Rota Teq) is available through VFC. This vaccine is covered by Medicaid only through the VFC Program for children ages 6 weeks through 32 weeks. When filing claims, procedure code 90680 must be used with modifiers EP and TJ. For paper claims, providers must enter a type of service code "6" and the modifiers.

For beneficiaries of the ARKids First-B Program, this procedure must be billed with modifier TJ. For paper claims, a type of service code "1" and the modifier TJ are required.

II. Procedure code 90648, "hemophilus influenza b vaccine (Hib), PRP-T conjugate (4 dose schedule), for intramuscular use", available through the VFC program, is covered by Medicaid only through the VFC program for beneficiaries under age 19. Claims require modifiers EP and TJ. When filing claims on paper, a type of service code "6" is required along with the modifiers.

For beneficiaries of the ARKids First-B Program, this procedure code must be billed with modifier TJ. Paper claims require a type of service code "1" and the modifier TJ.

Thank you for your participation in the Arkansas Medicaid Program.

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