016.06.06 Ark. Code R. 055 - Vaccines Available in the Vaccines for Children (VFC) Program

The purpose of this Official Notice is to inform providers of vaccines available through the VFC Program, conditions of coverage and billing instructions.

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.

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.

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, official notices and remittance advice (RA) messages are available for downloading from the Arkansas Medicaid website: www.medicaid.state.ar.us.

Roy Jeffus, Director

Notes

016.06.06 Ark. Code R. 055

9/8/2006