Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.06-023 - Official Notice DMS-2006-A-3, DMS-2006-AR-2, DMS-2006-G-2, DMS-2006-II-3, DMS-2006-L-3, DMS-2006-KK-3, DMS-2006-R-3, DMS-2006-OO-2 - Vaccines Available in the Vaccines for Children (VFC) Program

Current through Register Vol. 49, No. 6, June, 2024
Vaccines Available in the Vaccines for Children (VFC)
				Program
The purpose of this Official Notice is to inform providers of
				vaccines recently available through the VFC program and to furnish billing
				instructions. The effective dates for VFC reimbursement for the administration
				of the vaccines identified in this notice are based on the availability of
				vaccines through VFC. Coverage and billing for ages 19 years and above are
				unchanged.
I. Hepatitis A vaccine,
			 pediatric/adolescent dosage - 2 dose schedule, for intramuscular use, 90633 is
			 now available through the VFC Program. Effective for dates of service on and
			 after March 1, 2006, Medicaid will only reimburse providers for administering
			 the vaccine. Reimbursement will be retroactive to March 1, 2006.
For dates of service on or after March 1, 2006, claims must be
				filed using the following procedure code with modifiers and type of service.
				Claims for the administration of the Hepatitis A 2-dose vaccine may be filed
				upon receipt of this Official Notice.
Category
Procedure Code
Electronic Claims Modifiers
Paper Claims Modifiers and Type of
						  Service
Regular Medicaid (Includes ARKids A)
90633
TJ, EP
TJ, EP, type of service 6
ARKids First-B
90633
TJ
TJ, type of service 1
II.
			 Hepatitis A vaccine pediatric/adolescent dosage - 3-dose schedule for
			 intramuscular use, 90634, is now available through the VFC Program. Effective
			 for dates of service on and after March 1, 2006, Medicaid will reimburse
			 providers only for administering the vaccine. Reimbursement will be retroactive
			 to March 1, 2006.
For dates of service on and after March 1, 2006, claims must be
				filed using the following procedure code and applicable modifiers. Claims for
				the administration of Hepatitis A vaccine 3-dose may be filed upon receipt of
				this Official Notice.
Category
Procedure Code
Electronic Claims Modifiers
Paper Claims Modifiers and Type of
						  Service
Regular Medicaid (Includes ARKids A)
90634
TJ, EP
TJ, EP, type of service 6
ARKids First-B
90634
TJ
TJ, type of service 1
III.
			 Measles, Mumps, Rubella and Varicella vaccine (MMRV), live for subcutaneous
			 use, 90710, is now available through the Vaccines for Children (VFC) Program.
			 Effective for dates of service on and after March 1, 2006, Medicaid will
			 reimburse providers only for administering the vaccine. Reimbursement will be
			 retroactive to March 1, 2006.
For dates of service on and after March 1, 2006, claims must be
				filed using the following procedure code and applicable modifiers. Claims for
				Measles, Mumps, Rubella and Varicella vaccine (MMRV) may be filed upon receipt
				of this Official Notice.
Category
Procedure Code
Electronic Claims Modifiers
Paper Claims Modifiers and Type of
						  Service
Regular Medicaid (Includes ARKids A)
90710
TJ, EP
TJ, EP, type of service 6
ARKids First-B
90710
TJ
TJ, type of service 1
IV.
			 Tetanus, Diphtheria, Toxoids and Acellular Pertussis vaccine (Tdap) for use in
			 individuals 7 years or older, for intramuscular use, 90715, is now available
			 through the Vaccines for Children (VFC) Program. Effective for dates of service
			 on and after March 1, 2006, Medicaid will reimburse providers only for
			 administering the vaccine. Reimbursement will be retroactive to March 1, 2006.
For dates of service on and after March 1, 2006, claims must be
				filed using the following procedure code and applicable modifiers. Claims for
				the administration of Tetanus, Diphtheria, Toxoids and Acellular Pertussis
				vaccine (Tdap) may be filed upon receipt of this Official Notice.
Category
Procedure Code
Electronic Claims Modifiers
Paper Claims Modifiers and Type of
						  Service
Regular Medicaid (Includes ARKids A)
90715
TJ, EP
TJ, EP, type of service 6
ARKids B
90715
TJ
TJ, type of service 1
Thank you for your participation in the Arkansas Medicaid
				Program.
If you need this material in an alternative format, such as
				large print, please contact our Americans with Disabilities Act Coordinator at
				(501) 682-6789 and 1-877-708 -8191. Both telephone numbers are voice and
				TDD.
If you have questions regarding this notice, please contact the
				EDS Provider Assistance Center at In-State WATS 1-800-457 -4454, or locally and
				Out-of-State at (501) 376-2211.
Arkansas Medicaid provider manuals, (including update
				transmittals), official notices and remittance advice (RA) messages are
				available for downloading from the Arkansas Medicaid website:
www.medicaid.state.ar.us
Roy Jeffus, Director