N.J. Admin. Code § 10:58A-2.13 - New Jersey Vaccines for Children program

(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/NJ FamilyCare services. Medicaid/NJ FamilyCare programs shall 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," 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 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, N.J.S.A. 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 listed 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) APNs shall bill the HCPCS procedure codes 90465, 90466, 90467, 90468, 90471, 90472, 90473 or 90474 to receive reimbursement for administering vaccines under this program, as appropriate. See N.J.A.C. 10:58A-4.5(c).

(d) Vaccines that are covered by the VFC program but are administered to beneficiaries 19 years of age and older shall be billed with only the appropriate procedure code and be reimbursed the fee-for-service rate. The administration fee is included in the reimbursement for the vaccine. See N.J.A.C. 10:58A-4.2(j).

Notes

N.J. Admin. Code § 10:58A-2.13

New Rule, R.2000 d.144, effective 4/3/2000.
See: 31 N.J.R. 3968(a), 32 N.J.R. 1208(a).
Amended by R.2004 d.334, effective 9/7/2004.
See: 36 N.J.R. 312(a), 36 N.J.R. 4136(a).
Amended by R.2004 d.409, effective 11/1/2004.
See: 35 N.J.R. 4977(a), 36 N.J.R. 4968(a).
In (c), substituted "90471 and 90472" for "W9356".
Amended by R.2011 d.119, effective 4/18/2011.
See: 42 N.J.R. 2890(a), 43 N.J.R. 1015(a).
In the introductory paragraph of (a), deleted "-Plan A" following the first occurrence of "FamilyCare"; deleted former (a)1; recodified former (a)2 as (a)1; rewrote (a)1; added new (a)2; in (c), inserted "90465, 90466, 90467, 90468,", ", 90473 or 90474", and ", as appropriate", substituted a comma for "and" following "90471" and updated the N.J.A.C. reference; and rewrote (d). Amended by 56 N.J.R. 2191(a), effective 11/4/2024