Adult Immunizations

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Effective for dates of service on or after July 1, 2017, the South Carolina Department of Health and Human Services (SCDHHS) will cover the following vaccinations for Medicaid beneficiaries 19 years of age and older:

·        Serogroup B Meningococcal (MenB)

·        Measles, Mumps, and Rubella (MMR)

·        Varicella (VAR)

·        Measles, Mumps, Rubella, and Varicella (MMRV)

SCDHHS will reimburse providers for the administration of these immunizations in accordance with the Center for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices (ACIP) Adult Immunization Schedule.

When billing for vaccines for beneficiaries 19 years of age and older, the provider should bill for both the vaccine and the immunization administration code. For administration of the vaccine, providers should bill the Common Procedural Terminology (CPT) code 96372. Federally qualified health centers (FQHCs) should not bill for immunization administration but may bill for the vaccination in addition to an encounter code.

Medicaid recognizes the CPT codes listed below for billing of the vaccination:

 

 

Vaccination

CPT Code

Code Description

MenB

90620

Meningococcal recombinant protein and outer membrane vesicle vaccine, serogroup B (MenB), 2 dose schedule, for intramuscular use

90621

Meningococcal recombinant lipoprotein vaccine, serogroup B (MenB), 3 dose schedule, for intramuscular use

MMR

90707

Measles, mumps, and rubella virus vaccine (MMR), live, for subcutaneous use

VAR

90716

Varicella virus vaccine (VAR), live, for subcutaneous use

MMRV

90710

Measles, mumps, rubella, and varicella vaccine (MMRV), live, for subcutaneous use

 

Coverage for children through 18 years of age will continue to be provided through the Vaccine for Children (VFC) program. SCDHHS will continue to reimburse for the administration of age appropriate vaccinations provided to children when the vaccine is obtained through the VFC program.

For questions related to VFC or to enroll in that program, Medicaid providers should contact the South Carolina Department of Health & Environmental Control (SCDHEC) at the address included below.

Division of Immunization and Prevention

SC Department of Health and Environmental Control

Mills/Jarrett Complex

Post Office Box 101106

Columbia, SC 29211

(803) 898-0460 or (800) 27-SHOTS (outside of the Columbia area)

 

This bulletin applies to fee-for-service and Medicaid managed care organizations (MCOs). Beneficiaries enrolled with a Medicaid MCO should direct questions regarding claims and specific authorization to the Medicaid MCO. Claims for fee-for-service beneficiaries should be billed directly to Medicaid. Any future changes to reimbursement rates for these immunizations will be communicated through the standard fee schedule update process and may not be communicated via a Medicaid bulletin or alert.

If you have any questions regarding this policy, please contact the Provider Service Center at (888) 289-0709.

 

Thank you for your continued support of the South Carolina Healthy Connections Medicaid program. 

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