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CHDP Phase 2: Modifier SL Required for Vaccines For Children Immunizations

September 8, 2017

Effective July 1, 2017, Child Health and Disability Prevention (CHDP) claims processing officially transitioned to HIPAA compliant formats for billing of all CHDP services. One billing change required by the transition was for providers to enter modifier SL (state-supplied vaccine) on claims submitted for vaccines supplied by the Vaccines For Children (VFC) program.

Some provider claims have been denied with Remittance Advice Details (RAD) code 9641: The procedure code billed requires modifier SL. Providers may refer to the Part 2 Medi-Cal Vaccines For Children (VFC) Program provider manual section for help when billing vaccines. The manual section lists the various vaccines and explains the policy associated with billing each one, including required and optional modifiers.

Reminder:

The federal VFC program supplies free vaccines to enrolled physicians. Every Medi-Cal-eligible child younger than 19 years of age may receive vaccines supplied by the VFC program. To participate, providers must enroll in VFC even if already enrolled with Medi-Cal or the CHDP program. Providers billing VFC procedure codes are reimbursed for vaccine administration costs only.

References
For broader CHDP transition billing help, providers may refer to the following:

CHDP Frequently Asked Questions web page of the Medi-Cal website
CHDP Bright Futures Schedule for Health Assessments by Age Group table