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Network Matters
News and Information for the
Harvard Pilgrim Health Care Network

June 2015

Reimbursement for Certain Vaccines in Massachusetts

The Massachusetts Department of Public Health (MDPH) has announced the universal availability of certain state-supplied vaccines for children in Massachusetts. In compliance with the MDPH’s request, Harvard Pilgrim will reimburse Massachusetts providers who have already privately purchased influenza vaccines for the 2015-16 influenza season through March 31, 2016, and those who privately purchased vaccines for pediatric hepatitis A, Tdap, and varicella through September 30, 2015.

Billing for state-supplied and privately purchased vaccines

Harvard Pilgrim’s Vaccine and Immunization Payment Policy will remain the same. For Massachusetts-supplied vaccines, place the SL modifier in the primary modifier field and put the appropriate vaccine/immunization administration CPT code on a separate line; no reimbursement will be made for these vaccines, as they were supplied by the state. For vaccines you have purchased privately, bill both the CPT code representing the vaccine/immunization provided and the appropriate administration code that applies to the delivery method, but do not attach the SL modifier.
Please note that reimbursement for privately purchased influenza, pediatric hepatitis A, Tdap, and varicella vaccines applies only to Massachusetts providers who have already purchased the vaccines and have them in stock.

For more information

For more detailed information on the availability of vaccines supplied by Massachusetts, see the Adult Vaccine Availability Table and Childhood Vaccine Availability Table offered on the MDPH website. Review Harvard Pilgrim’s Vaccine and Immunization Payment Policy for details about vaccine reimbursement and provider billing guidelines.

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Eric H. Schultz,
President and Chief Executive Officer

Robert Farias,
Vice President, Network Services

Annmarie Dadoly,

Joseph O'Riordan,

Kristin Edmonston,
Production Coordinator