Reply To: Immunization Counseling/Office Visit CPT code

[Missouri Public Health Association]

You can’t use 90471 with any of the Medicaid managed plans. They will not pay it because you need to bill the correct cpt code with SL modifier for Medicaid kids getting vaccine through the VFC program. The code with the SL modifier is the administration fee you can bill for administration of the vaccine. Typically they pay about $8.07 per vaccine componet.
You can’t bill a 99393 EP unless you are doing an exam that correspondes to that cpt code.