Medicaid only allows reimbursement of $5.27 per component for immunizations. That is your admin fee. The state gives you the free vaccine so the $5.27 per component is paid to cover your admin costs. That is all you are allowed to recoup. You cannot bill more than that by using other codes such as the 99211. Each code has guidelines for approved use. You have to follow those guidelines. Insurance companies will often pay for the use of the 99211 code. Just because they pay it does not mean you are using it appropriately. When they audit and see that the visit, the charting and the coding does not meet guidelines you will be responsible for that overcharge.
For adults you can bill through the pharmacy benefit for vaccines if you are using purchased vaccine. At that point you can try to bill Medicaid for the 90471 admin fee. I am not sure how well they pay on that though. We certainly do not get reimbursed well enough to cover all costs but we have to bill correctly. Hope this information helps.
“MO HealthNet enrolled providers must participate in the VFC Program administered by the Missouri Department of Health and Senior Services and must use the free vaccine when administering vaccine to qualified MO HealthNet eligible children. Providers may bill for the administration of the free vaccine by using the appropriate VFC Administration Codes. Providers must not use any additional administration procedure code. The MO HealthNet reimbursement for the administration is $5.27 per component.”—-http://manuals.momed.com/collections/collection_phy/print.pdf