New Jersey Administrative Code
Title 10 - HUMAN SERVICES
Chapter 54 - PHYSICIAN SERVICES
Subchapter 8 - PHARMACEUTICAL SERVICES
Section 10:54-8.5 - New Jersey Vaccines for Children program

Universal Citation: NJ Admin Code 10:54-8.5

Current through Register Vol. 56, No. 18, September 16, 2024

(a) The New Jersey Vaccines for Children (VFC) program provides free vaccines for administration to beneficiaries under 19 years of age who are eligible for New Jersey Medicaid and NJ FamilyCare-Children's Program services. Medicaid and NJ FamilyCare-Children's Program will not provide reimbursement to providers for administering these vaccines exclusive of the VFC program.

1. The Center for Disease Control (CDC) is expected to periodically add vaccines to the approved list for the VFC program. This list, "VFC Resolutions," effective March 9, 2009, is hereby incorporated by reference, as amended and supplemented. The VFC Resolutions lists the vaccines provided by the VFC Program for individuals under age 19. The Medicaid/NJ FamilyCare-Children's Program shall not reimburse for any vaccine so added to the VFC Resolutions that are not obtained from the VFC Program. Providers can access the VFC Resolutions on the CDC website at http://www.cdc.gov/vaccines/.
i. Any change to the reimbursement amount for the administration of vaccines administered under the VFC Program and/or the reimbursement amounts for such vaccines that are also appropriate for and administered to individuals who are not under age 19 and are, therefore, ineligible to receive them under the VFC Program, will be made by rulemaking in accordance with the Administrative Procedure Act, 52:14B-1 et seq.

2. Providers shall receive an administration fee for the administration of vaccines ordered directly from the VFC Program. The Medicaid/NJ FamilyCare program shall not provide reimbursement to providers for administering vaccines that are not obtained from the VFC Program.

(b) The vaccines described in (a)1 above may be provided to any child without health insurance and those children who are American Indian or an Alaskan Native.

(c) Providers shall bill the HCPCs procedure code 90471, 90472, 90473 or 90474 to receive reimbursement for administering vaccines under this program, as appropriate. See 10:58A-4.5(c).

(d) Vaccines administered to beneficiaries 19 years of age and older shall be billed with the appropriate procedure code. See 10:54-9.4.

Disclaimer: These regulations may not be the most recent version. New Jersey may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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