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Elizabeth M. Whitehorn, Director

Provider Notice issued 09/25/2024

 

To: Enrolled Pharmacies
​Date September 25, 2024
​Re:
 Influenza Vaccines Billed by Pharmacies

This notice informs pharmacies that the 2024-2025 influenza vaccine National Drug Codes (NDCs) have been loaded to the Pharmacy Billing Management System (PBMS) and can now be billed.To receive the vaccine administration fee, pharmacies billing the Medicaid fee-for-service (FFS) program should enter the administration fee amount in the Incentive Amount Submitted field (438-E3). If the value in this field exceeds $6.40, the maximum allowed by the Department of Healthcare and Family Services (HFS), the claim will only pay an administration fee of $6.40. If the value of the field is less than or equal to the HFS allowed amount, the system will pay the lesser of the two. The value ‘MA’ must be entered in the Professional Service Code field (440-E5) unless no administration fee is billed. The claim will reject if it is submitted with an incorrect value in one of these fields. If a claim is submitted with an NDC for an influenza vaccine, but neither of these fields is populated, no administration fee will be paid.

For managed care organization (MCO) claims, please contact the applicable MCO for billing instructions.

Questions regarding this notice should be directed to a billing consultant in the Bureau of Professional and Ancillary Services at 877-782-5565.

 

Kelly Cunningham, Administrator
Division of Medical Programs