Vaccines for Children (VFC) Program
The Vaccines for Children Program helps provide vaccines to eligible children and adolescents whose families cannot otherwise afford immunization services. VFC-registered providers administer the vaccines through this program as follows [34,35]:
- Eligible patients receive vaccines free of charge, as vaccine products have already been paid for with federal tax dollars 
- The provider may charge families/caregivers of eligible patients an administration fee for VFC vaccines 
- Administration fees vary by state and are based on a regional scale determined by the Centers for Medicare and Medicaid Services (CMS) 
- Administrative fees represent the maximum amount that providers may charge for each vaccine administered. Providers have the option to charge what they feel is fair, including no charge at all, without exceeding this maximum 
- VFC vaccines can be administered by any enrolled VFC Program provider (private doctor, private clinic, hospitals, public health clinic, community health clinic, schools, etc) 
Check with your local Medicaid office to find the regional cap for your state.
Coding for State-supplied or Free Vaccines
There are many other federally and state-funded programs that provide vaccines at no cost (eg, public health clinics, federally qualified health centers, rural health clinics). 
- Providers may not bill or attempt to obtain payment for "free" vaccines 
- Some insurers may require providers to append a modifier (eg, "SL") to the vaccine or toxoid code to designate its "free" status [36,37]
- They may also require an SA modifier for nurse practitioners who administer free vaccines 
- Administration fees may also require modifiers in some instances 
- Please be sure to check the insurer's guidelines before reporting administration services for free vaccines to avoid submitting fraudulent claims
For state health department phone numbers, go to www.immunize.org/coordinators.
For a comprehensive, up-to-date directory of immunization resources, go to www.immunize.org/resources. 
You must check the insurer's guidelines for documenting vaccines obtained at no cost ("free") before submitting claims for administering such immunizations.
826034R0 October 2017
Please note that this website is provided for informational purposes only and is not intended to serve as comprehensive training on medical billing and coding. Additional training on medical coding may be required. The information on this website is believed to be accurate as of the date of publication. Users should independently verify accuracy.
Healthcare providers are responsible for making the ultimate decision on when to use a specific product based on clinical recommendations and how to bill for products and related services rendered. Consult third-party insurers' guidelines for specific information regarding the billing and reporting of services rendered.