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24.3.20.7 Rotavirus Vaccine and Tdap Vaccine
Rotavirus vaccine is a benefit of the CSHCN Services Program when administered according to the ACIP recommendations. Providers must use procedure code 1-90680 or 1-90715 in addition to the related immunization administration procedure code to submit claims when the vaccine is obtained from the TVFC Program.
Procedure code 1-90680 or 1-90715 may be reimbursed when the vaccination is not obtained from TVFC and one of the following conditions are met.
• A provider who is not enrolled in the TVFC Program has purchased the vaccine.
•The client does not meet the TVFC criteria.
•TVFC resolutions do not match the ACIP's general usage recommendations.
•The provider purchases an ACIP-recommended vaccine that is not distributed by TVFC.
Claims must be billed using the state-identified modifier U4.
The CSHCN Services Program may only reimburse the administration fee for a vaccine obtained from the TVFC Program.
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