Immunization Billing Guidance for Minnesota Vaccines for Children (MnVFC) - Minnesota Dept. of Health

Immunization Billing Guidance for MnVFC

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1: Charge only allowable fees for MnVFC.
2: Be prepared to remove vaccine charges from a MnVFC-eligible patient's bill.
3: Waive the administration fee if a patient is unable to pay it.
4: Enter the correct CPT code for each vaccine.
5: Information for complex billing questions for MnVFC-eligible patients.

This document provides guidance for your site’s billing office if they get calls from patients who have questions about the MnVFC program or who request that their bill be adjusted.  

1: Charge only allowable fees for MnVFC.

There are three costs that may be associated with each immunization. The cost of the vaccine, administering the vaccine, and the office visit. MnVFC vaccine is provided to your site at no charge. You cannot bill a Minnesota Heath Care Program (MHCP) or charge the patient for the cost of this vaccine. The program caps the administration fee you may charge MnVFC-eligible patients at $21.22 per dose (not per vaccine antigen) for MnVFC vaccine. This fee limit is set by federal law. You may also charge for the office visit.

    Permissible MnVFC vaccine administration fees and charges
    Patient's status MnVFC eligible? Cost of vaccine Administration fee
    Minnesota Health Care Program (MHCP) Yes
    • Use MnVFC vaccine.
    • Don't bill or charge for the cost of the vaccine.
    • Bill the MHCP $21.22 per dose.
    • Certain sites including FQHC, RHC, IHS and tribal clinics may bill an encounter fee for the entire visit and this is allowable.
    Uninsured Yes
    • Use MnVFC vaccine.
    • Don't charge for the cost of the vaccine.
    • Charge the patient $21.22 or less per dose.
    American Indian/Alaska native Yes
    • May use MnVFC vaccine.
    • Don't bill or charge for the cost of the vaccine.
    • However, if the patient is privately insured and prefers to use insurance, use private vaccine and bill the insurance.
    • If covered by an MHCP, bill the MHCP $21.22 per dose.
    • If un- or underinsured, charge the patient $21.22 or less per dose.
    • If privately insured and prefers to use insurance, bill the insurance for the fee.
    Underinsured Only at local public health (LPH), Federally Qualified Health Centers (FQHC), Rural Health Centers (RHC), Indian Health Services (IHS), and tribal clinics:
    Yes
    • Use MnVFC vaccine.
    • Don't charge for the cost of the vaccine.
    • Charge the patient $21.22 or less per dose.
    At a site that is not eligible to see underinsured children:
    No
    • Consider sending the patient to a site where they would be eligible for MnVFC.
    • If the patient stays at a private site, do not use MnVFC vaccine.
    • Consider sending the patient to a site where they would be eligible for MnVFC.
    Insured No
    • Use private vaccine.
    • Bill the insurance.
    • Bill the usual and customary administration fee to the insurance


    To be reimbursed for the administration fee for patients enrolled in an MHCP, you must follow the billing procedures of each program. MHCP programs include Medical Assistance (MA) and MinnesotaCare. For billing questions, call the Minnesota Department of Human Services (DHS) at
    651-431-2700.

2: Be prepared to respond to questions about MnVFC eligibility.

Your site screens patients to find out if they are eligible for the MnVFC program before giving them immunizations and keeps that screening information on file. For up-to-date details on eligibility, see the MnVFC Patient Eligibility Screening Record forms.

The MnVFC program has a self-screening form for children that parents can fill out called Can my child get free or low-cost shots? You might find it a useful reference as well.

3: Waive the administration fee if a patient is unable to pay it.

MnVFC-eligible patients may not be denied vaccine for failure to pay an administration fee. You may charge a patient for the administration fee, but if they are unable to pay this fee it should be removed from their bill. Do not send these bills to collections.

4: Enter the correct CPT code for each vaccine.

This not only affects the patient’s bill but also their immunization record in the statewide immunization registry (called the Minnesota Immunization Information Connection, or MIIC), which is often derived directly from billing data. Add the SL modifier to the CPT code when billing for MnVFC-eligible children.

5: Information for complex billing questions for MnVFC-eligible patients:

  1. Call the number on the back of the health care plan card.
  2. For billing questions about MHCP program, call the DHS provider helpdesk at 651-431-2700.
  3. For questions about the MnVFC program, call: 651-201-5522 or 1-800-657-3970 or see Immunization Program Billing.  

Updated Wednesday, July 13, 2016 at 03:47PM