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TO:  Hospital Providers, Physicians, Nurse Practitioners, Physician Assistants, County Health Departments, Federally Qualified Health Centers, and Rural Health Clinics

RE:  New Coverage for ACIP Recommended Vaccines
(for Non-Pharmacy Providers)

Effective for dates of service on or after October 1, 2023, Alabama Medicaid received approval to cover the Advisory Committee on Immunization Practices (ACIP) recommended vaccines and their administration, without cost sharing, for adults aged 19 and older.

·       For a list of ACIP recommended vaccines, please visit the following website:

https://www.cdc.gov/vaccines/hcp/acip-recs/index.html.
Changes to ACIP recommendations will be incorporated into coverage and billing codes as necessary.

·       Information regarding adult immunizations may be found in Appendix H of the Provider Billing Manual.

·        Information regarding Vaccines for Children (VFC) may be found in Appendix A of the Provider Billing Manual.

·        Information regarding covered vaccine procedure codes and vaccine administration codes may be found on the Physician Drug Fee Schedule: https://medicaid.alabama.gov/content/Gated/7.3G_Fee_Schedules.aspx.

When filing a claim:

·        Vaccines are reimbursable on a fee-for-service basis using the appropriate CPT code. The administration fee is included in the price of the vaccine.

·        The administration fee may be billed separately if an office visit is not billed.

·        Provider should bill only the vaccine administration fee if the vaccine is provided at no cost to the provider from federal resources.

Providers with billing questions may contact the Gainwell Technologies Provider Assistance Center at 1-800-688-7989. Providers with policy questions may contact Medicaid’s Physician Program at Physicians.Program@medicaid.alabama.gov.

 The Current Procedural Terminology (CPT) and Current Dental Terminology (CDT) codes descriptors, and other data are copyright © 2023 American
  Medical Association and © 2023 American Dental Association (or such other date publication of CPT and CDT). All rights reserved. Applicable FARS/DFARS apply.