TMPPM 2007 >43.1.9.2 Immunizations

The specific diagnosis necessitating the vaccine/toxoid is required when billing with administration procedure codes 1/S-90465, 1/S-90466, 1/S-90467, 1/S-90468, 1/S-90471, 1/S-90472, 1/S-90473, and 1/S-90474 in combination with the appropriate vaccine administration code in the following table. For clients birth through 20 years of age, diagnosis code V202 may be used unless a more specific diagnosis code is appropriate

For all immunizations, if only one immunization is administered during a check up or visit, providers should bill administration procedure code 1/S-90465, 1/S-90467, 1/S-90471, and 1/S-90473 with a quantity of 1 in addition to the appropriate national code that describes the immunization administered.

If two or more immunizations are administered, providers should bill administration procedure codes 1/S-90465, 1/S-90467, 1/S-90471, or 1/S-90473 with a quantity of 1, procedure codes 1/S-90466, 1/S-90468, 1/S-90472, or 1/S-90474 with a quantity of 1 or more (depending on the number of vaccines administered), and the procedure codes that describe each immunization administered. The procedure codes that identify each vaccine are considered informational but are required on the claim.

Immunization administration fees are reimbursed based on the number of state-defined components (as identified on the table below) administered per injection: one state-defined component, $8 (no modifier); two state-defined components, $12 (modifier U2); three state-defined components, $16.00 (modifier U3). Combined antigen vaccines (e.g., DTaP or MMR) are reimbursed as one dose.


Vaccine Procedure Code	No. of Components
1/S-90632*	1
1/S-90633*	1
1-90636	2
1/S-90645	1
1/S-90646	1
1/S-90647	1
1/S-90648*	1
1/S-90649*	1
1/S-90655*	1
1/S-90656*	1
1/S-90657*	1
1/S-90658*	1
1/S-90660*	1
1/S-90669*	1
1/S-90680*	1
1/S-90700*	1
1/S-90702*	1
1-90703	1
1/S-90707*	1
1/S-90710*	2
1/S-90713*	1
1/S-90714*	1
1/S-90715*	2
1/S-90716*	1
1/S-90718	1
1/S-90723*	3
1-90732*	1
1/S-90733	1
1/S-90734*	1
1-90740	1
1/S-90744*	1
1/S-90746*	1
1-90747	1
1/S-90748*	2
1/S-90749	1
* Texas Vaccines For Children (TVFC) distributed vaccine/toxoid.

Providers may use the state defined modifier U1, as described below, in addition to the associated administered vaccine procedure code.


Modifiers	Description
U1	State-defined modifier: Vaccine is unavailable from TVFC. * U1 modifier only applies to the following vaccines: influenza, HPV and rotavirus, MMRV, and Tdap
U2	State-defined modifier: Administration of vaccine/toxoid with two state defined components
U3	State-defined modifier: Administration of vaccine/toxoid with three state defined components
* "Unavailable" is defined as: A new vaccine approved by the Advisory Committee on Immunization Practices (ACIP) that has not been negotiated or added to a TVFC contract, funding for new vaccine that has not been established by TVFC, or national supply and/or distribution issues. Modifier U1 may not be used for failure to enroll in TVFC or to maintain sufficient TVFC vaccine/toxoid inventory.

Exception: Medical contraindications and exclusions from immunizations for reasons of conscience (including a religious belief and parental/client refusal) are the only acceptable reasons for not administering immunizations.

Refer to: "Immunizations Overview" on page H-2 for exclusions from immunizations.