Vaccines for Children Policy and Coding Update

The South Carolina Department of Health and Human Services (SCDHHS) is issuing a clarification regarding billing for vaccine administration current procedural terminology (CPT) codes 90460 and 90461 for vaccines obtained through the Vaccines for Children (VFC) program to Healthy Connections Medicaid-enrolled children. The guidance included in this bulletin replaces existing SCDHHS guidance on this topic, including the agency’s Oct. 15, 2020, bulletin .

 

Based on direction from the Centers for Medicare and Medicaid Services (CMS), 90461 will be a non-covered code; therefore, SCDHHS will not reimburse for this code for dates on or after Sept. 1, 2021. CMS has informed SCDHHS the VFC program does not cover component-based vaccine counseling. Only CPT code 90460 should be used for vaccine administration and counseling for children.

SCDHHS will continue to reimburse providers for administering age-appropriate vaccinations. For Healthy Connections Medicaid-enrolled children, providers must continue to obtain vaccine doses through the VFC program.

Providers should direct any questions related to this policy update to the SCDHHS Provider Service Center at (888) 289-0709. The Provider Service Center’s hours of operations are 7:30 a.m.-5 p.m. Monday-Thursday and 8:30 a.m.-5 p.m. Friday.

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

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