N.J. Admin. Code § 10:66-2.20

Current through Register Vol. 56, No. 11, June 3, 2024

Section 10:66-2.20 - Vaccines for Children program

(a) The Vaccines for Children (VFC) program provides free vaccines for administration to beneficiaries under 19 years of age who are eligible for New Jersey Medicaid and NJ FamilyCare--Plan A services. The vaccines covered under the VFC program may also be provided to any child without health insurance and to any child who is an American Indian or an Alaskan Native.

(b) Providers shall receive an enhanced administration fee for the administration of vaccines ordered directly from the VFC Program. The Medicaid/NJ FamilyCare--Plan A program shall not provide reimbursement to providers for administering vaccines that are not obtained from the VFC program.

(c) The Centers for Disease Control and Prevention (CDC) is expected to periodically update the approved list of vaccines covered under the VFC program. The Medicaid/NJ FamilyCare--Plan A program will not reimburse for any vaccine so added to the VFC list of approved vaccines that are not obtained from the VFC program. Upon receipt of updates from the CDC, the Medicaid/NJ FamilyCare Program will update the list of VFC-covered vaccines at N.J.A.C. 10:66-6.2(q) by notice of administrative change.

(d) Providers shall bill the HCPCS procedure codes 90465, 90466, 90467, 90468, 90471, 90472, 90473 or 90474 when administering vaccines under this program, as appropriate.

(e) Vaccines which are covered by the VFC program but are administered to beneficiaries over 19 years of age shall be billed with only the appropriate HCPCS procedure code and be reimbursed the fee-for-service rate. The administration fee is included in the reimbursement for the vaccine.

N.J. Admin. Code § 10:66-2.20

Amended by 49 N.J.R. 1405(a), effective 6/5/2017