Immunization Billing Guidance for MnVFC Replacement Method Sites

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On this page:
1: Charge only allowable fees for MnVFC.
2: Be prepared to remove vaccine charges from a MnVFC-eligible patient's bill.
3: Waive the administration fee if a patient is unable to pay it.
4: Enter the correct CPT code for each vaccine.
5: Information for complex billing questions for MnVFC-eligible patients.

This document provides guidance for your site's billing office if they get calls from patients who have questions about the MnVFC program or who request that their bill be adjusted.

1. Charge only allowable fees for MnVFC.

There are three costs that may be associated with each immunization. The cost of the vaccine, administering the vaccine, and the office visit. MnVFC vaccine is provided to your site at no charge. You cannot bill a Minnesota Heath Care Program (MHCP) or charge the patient for the cost of this vaccine. The program caps the administration fee you may charge MnVFC-eligible patients at $21.22 per dose (not per vaccine antigen) for MnVFC vaccine. This fee limit is set by federal law. You may also charge for the office visit.

Permissible MnVFC vaccine administration fees and charges

To be reimbursed for the administration fee for patients enrolled in an MHCP, you must follow the billing procedures of each program. MHCP programs include Medical Assistance (MA) and MinnesotaCare. For billing questions, call the Minnesota Department of Human Services (DHS) at 651-431-2700.

2. Be prepared to respond to questions about MnVFC eligibility.

Your site screens patients to find out if they are eligible for the MnVFC program before giving them immunizations and keeps that screening information on file. For up-to-date details on eligibility, see the MnVFC Patient Eligibility Screening Record forms.

The MnVFC program has a self-screening form for children that parents can fill out called Can my child get free or low-cost shots? You might find it a useful reference as well.

3. Waive the administration fee if a patient is unable to pay it.

MnVFC-eligible patients may not be denied vaccine for failure to pay an administration fee. You may charge a patient for the administration fee, but if they are unable to pay this fee it should be removed from their bill. Do not send more than one bill and do not send bills to collections.

4. Enter the correct CPT code for each vaccine.

This not only affects the patient's bill but also their immunization record in the statewide immunization registry (called the Minnesota Immunization Information Connection, or MIIC), which is often derived directly from billing data. Add the SL modifier to the CPT code when billing for MnVFC-eligible children.

5. Information for complex billing questions for MnVFC-eligible patients:

1. Call the number on the back of the health care plan card.
2. For billing questions about MHCP program, call the DHS provider helpdesk at 651-431-2700.
3. For questions about the MnVFC program, call: 651-201-5522 or 1-800-657-3970 or see Immunization Program Billing.