Immunizations and Vaccinations

Revised: October 7, 2025

· Overview

· Eligible Providers

· Covered Services

· Minnesota Vaccines for Children (MnVFC)

· Seasonal Influenza Vaccines

· Immunization and Vaccine Benefits Codes

· COVID-19 Vaccine Provided in a Home Setting

· Vaccine Counseling

· Noncovered Services

· Billing

· Billing for Vaccines

· Billing for Child Vaccines

· Billing for Adult Vaccines and Non MnVFC Vaccines

· Legal References

Overview

The Minnesota Health Care Programs (MHCP) Immunization and Vaccination program outlines coverage and billing policy for children and adults. The Minnesota Department of Health (MDH) Immunization for Health Care Providers webpage contains best practices and other information related to the program.

Eligible Providers

The following MHCP-enrolled health care providers may bill for vaccines and toxoids, and administering vaccines and toxoids:

· Certified family nurse practitioners

· Certified nurse-midwives

· Certified pediatric nurse practitioners

· Child and Teen Checkups providers

· Clinics

· Community paramedics

· Convenience clinics

· Dental providers

· Home health agencies

· Outpatient and inpatient hospitals

· Pharmacies

· Physicians

· Podiatrists

· Public health clinics

· Public health nursing clinic providers

Pharmacy
Pharmacists can bill for influenza vaccines administered to members ages 6 and older; all other vaccines to people who are aged 13 or older by written prescription with a physician, or advanced practice nurse or physician assistant authorized to prescribe drugs, provided that the pharmacist meets the following:

· Completion of a program approved by the American Council of Pharmaceutical Education for the administration of vaccinations or a program approved by the Board of Pharmacy

· Reports the administration of the vaccinations to the Minnesota Immunization Information Connection (MIIC)

· Uses the MIIC to assess the immunization status of a person before administering vaccines, except when administering influenza vaccines to a person age nine or older

Dental Providers
Dentists who meet all of the following requirements may administer influenza vaccines to members age 19 and older:

· Trained in or have successfully completed a program approved by the Minnesota Board of Dentistry specifically for the administration of immunizations and must submit attestation on the Immunization Delivery for Dentists Provider Assurance Statement (DHS-7121) (PDF)

· Have immediate access to emergency response equipment, including but not limited to oxygen administration equipment, epinephrine, and other allergic reaction response equipment

· Reports the administration of the immunization to MIIC or the patient’s primary physician or clinic

Community Paramedics
MHCP covers services provided by certified community paramedics for:

· Administration provided to an MHCP member who has received hospital emergency department services three or more times in four consecutive months within a twelve-month period; or

· Are identified by or require one or more of the following:

· Are identified by their primary care provider at risk of nursing home placement

· May require set-up of services for discharge from a nursing home or hospital

· May require services to prevent re-admission to a nursing home or hospital

Claims must be billed by the MHCP-enrolled medical director of the ambulance service who employs the paramedic.

The following MHCP-enrolled providers are eligible to bill for the administration of COVID-19 vaccines:

· Dentist (can no longer administer COVID-19 vaccines effective July 1, 2022)

· Federally qualified health center (FQHC)

· Home health agency

· Hospice

· Hospital

· Indian Health Facility provider

· Nurse midwife

· Nurse practitioner

· Optometrist

· Pharmacy

· Physician

· Physician assistant

· Podiatrist

· Public health clinic

· Public health nursing organization

· Rehabilitation agency

· Renal dialysis free standing

· Rural health clinic

The following list of health care providers and students in a health care profession not enrolled in MHCP are approved to administer COVID-19 vaccines using the national provider identifier (NPI) of the MHCP-actively enrolled supervisor or organization (who qualifies in the previous category):

· Any medical, nursing, pharmacy, pharmacy intern, midwife, paramedic, advanced or intermediate EMT, physician assistant, respiratory therapy, dental, podiatry, optometry or veterinary (Must have appropriate training in administering vaccines as determined by their school or training program and supervision by a currently practicing health care professional experienced in administering intramuscular injections.)

· Inactive, expired or lapsed licenses within the last five years

· Any physician, advanced practice registered nurse, registered nurse, practical nurse, pharmacist, pharmacy intern, midwife, paramedic, advanced or intermediate EMT, respiratory therapist, dentist, physician assistant, podiatrist, optometrist, veterinarian

· Respiratory therapist

· Veterinarian

Providers must keep documentation on who administered the COVID-19 vaccine if a supervisor or organization is listed as the rendering or treating provider for auditing purposes.

The following providers are also eligible to provide vaccine counseling to members:

· Hospice

· Indian Health Facility providers

· Optometrist

· Rehabilitation agency

· Renal dialysis free standing clinic

· Rural health clinic

Covered Services

MHCP covers the following services:

· Vaccines

· Toxoids

· Administering vaccines and toxoids, including those available through the MnVFC program

· Office visits associated with administering vaccinations when the appointment is not solely to administer vaccines

· COVID-19 vaccines

· Vaccine counseling

Minnesota Vaccines for Children (MnVFC)

MHCP providers administering pediatric vaccines within the scope of their licensure, and who are enrolled as a Medical Assistance provider, must enroll in the Minnesota Vaccines for Children (MnVFC) program. The MnVFC program provides public purchased vaccines for children ages 0-18 years at no cost. These vaccines meet the recommendations of the Advisory Committee on Immunization Practices (ACIP) and are approved by the Centers for Disease Control and Prevention (CDC).

MHCP does not reimburse for MnVFC covered vaccines purchased outside the program but will pay for the administration of those vaccinations.

Seasonal Influenza Vaccines

Pediatric influenza vaccines must be obtained from the MnVFC program when available. Availability of annual seasonal influenza vaccine and distribution timing varies. Up-to-date information is available through MDH on the Immunization Information for Health Care Providers webpage.

Immunization and Vaccine Benefits Codes

· Immunization and Vaccine Benefits Codes for Children: Provider must check availability and obtain immunization and vaccines from MnVFC for children ages 0-18 years first, before administering and purchasing on their own.

· Immunization and Vaccine Benefits Codes for Adults

The MnVFC program is now distributing the COVID-19 vaccines approved by the Food and Drug Administration under an Emergency Use Authorization (EUA). Providers may not seek reimbursement for any vaccine that a federal distribution program provides at no cost. However, MHCP will reimburse the cost for the administration of the vaccines if covered through MHCP.

The COVID-19 vaccines have EUA which may be changed at any time. EUA is separate from a public health emergency.

COVID-19 Vaccine Provided in a Home Setting

MHCP will follow Medicare’s updated payment policy for administering the COVID-19 vaccine in the home if administering a COVID-19 vaccine is the only service performed at that time. Bill the appropriate administration code for the vaccine with place of service 12. Providers are not eligible for the additional amount if another MHCP service in the same home on the same date of service occurs. In those situations, MHCP pays for administering the COVID-19 vaccine at the standard amount.

If you administer the COVID-19 vaccine to more than one MHCP member in a single home in the same multi-unit or communal living arrangement on the same day, MHCP pays according to the following:

· For dates of service between June 8, 2021, and Aug. 24, 2021, MHCP pays the additional payment once per date of service in that home, regardless of how many MHCP members receive the vaccine.

· Effective on Aug. 24, 2021, MHCP pays the additional payment amount for up to a maximum of five vaccine administration services per home unit or communal space within a single group living location; but only when fewer than 10 MHCP members receive a COVID-19 vaccine dose on the same day at the same group living location. When 10 or more MHCP members receive a COVID-19 vaccine dose at a group living location on the same day, the additional payment can only be billed once per home (whether the home is an individual living unit or a communal space).

Providers must keep documentation on who administered the COVID-19 vaccine if a supervisor or organization is listed as the rendering or treating provider for auditing purposes.

Vaccine Counseling

Effective Jan. 1, 2022, MHCP covers vaccine counseling. Providers may counsel for COVID-19 vaccinations and standard vaccines. Counseling may be provided both in-person and through telehealth. Providers billing for vaccine counseling services must have the ability to administer the vaccine for which they are counseling. Providers cannot bill for vaccine counseling separately if the counseling is a required component of another service provided in the same visit.

Noncovered Services

MHCP does not cover the following services:

· Reimbursement for vaccines available from the MnVFC program

· Reimbursement for vaccines is not available under Individual Education Program (IEP) services

· Immunizations administered concurrently with services for the treatment of emergency medical conditions

Members enrolled in the following MHCP programs are not eligible for vaccination services:

· AC - Alternative Care Program

· HH - HIV/AIDS

· EH - Emergency Medical Assistance

· FPMN - Family Planning Program

Billing

The MHCP fee schedule is available to verify reimbursement rates.

Billing for Vaccine Counseling

HCPCS Code	Vaccine Counseling Description	Modifiers
G0310	Immunization counseling by a physician or other qualified health care professional when the vaccine is not administered on the same date of service, 5 to 15 minutes time. This code is used for Medicaid billing purposes.
G0311	Immunization counseling by a physician or other qualified health care professional when the vaccine is not administered on the same date of service, 16-30 minutes time. This code is used for Medicaid billing purposes.
G0312	Immunization counseling by a physician or other qualified health care professional when the vaccine is not administered on the same date of service for ages under 21, 5 to 15 minutes time. This code is used for Medicaid billing purposes.
G0313	Immunization counseling by a physician or other qualified health care professional when the vaccine is not administered on the same date of service for ages under 21, 16-30 minutes time. This code is used for Medicaid billing purposes.
G0314	Immunization counseling by a physician or other qualified health care professional for COVID-19 vaccines, ages under 21, 16-30 minutes time. This code is used for the Medicaid Early and Periodic Screening, Diagnostic, and Treatment Benefit (EPSDT).	Use modifier CR when counseling specifically for COVID-19.
G0315	Immunization counseling by a physician or other qualified health care professional for COVID-19 vaccines, ages under 21, 5-15 minutes time. This code is used for the Medicaid Early and Periodic Screening, Diagnostic, and Treatment Benefit (EPSDT).	Use modifier CR when counseling specifically for COVID-19.

Bill only one counseling session for each member per day, but there is no limit to the number of times counseling may be provided to an individual.

Billing for Vaccines

Submit all claims with a vaccine code and vaccine administration code billed on the same date of service, otherwise it will deny. Providers can also bill office visits when administering vaccinations if the visit was not solely to administer vaccines.

Billing for Child Vaccines

Some children’s vaccines and toxoids are not available through the MnVFC program. Providers should follow Billing for Adult Vaccines protocol for these vaccines.

For vaccines obtained through the MnVFC Program:

The MnVFC program caps the administration fee you may charge at $21.22 per dose (not per vaccine antigen). Refer to the Immunization Billing Guidance for MnVFC (PDF) for more information.

Refer to the following when billing for vaccines obtained through MnVFC:

· Use the 837P or 837I MN–ITS transaction.

· Enter the appropriate CPT vaccine code with the SL modifier and a $0 charge.

· Enter the appropriate vaccine administration code (from the following table) on the same claim.

· Enter the administration charge (no more than $21.22 per dose) for administering the vaccine.

· Use the codes listed after “without counseling” when counseling is not provided.

CPT Administration Code	Vaccine Administration Description	Use With
With counseling
90460	Immunization administration through any route with counseling by physician or other qualified heath care professional; first or only component of each vaccine or toxoid administered.	Use 90461 for each additional vaccine or toxoid component (must be used together with code 90460 if two or more vaccines administered).
90480	Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (sars-cov2) (coronavirus disease [covid-19]) vaccine, single dose.	Use the administration of vaccine only for COVID-19 vaccines. If, you provide vaccine counseling on the day you also administer the COVID-19 vaccine, you may not report counseling separately since code 90480 is valued to include counseling. Do not report in conjunction with non-COVID-19 90476-90759 vaccines, toxoids.
96380	Administration of respiratory syncytial virus, monoclonal antibody, seasonal dose by intramuscular injection, with counseling by physician or other qualified health care professional	Use the administration only for the RSV monoclonal antibody product for date of service on, or after, Jan. 1, 2024, with counseling if obtained through MnVFC.
Without counseling
90471	Percutaneous, intradermal, subcutaneous, or intramuscular injections- 1 single or combination vaccine or toxoid	Use 90472 for each additional vaccine or toxoid, single or combination (must be used together with code 90471 if two or more vaccines administered).
90473	Intranasal or oral immunization administration- 1 single or combination vaccine or toxoid	Use 90474 for each additional vaccine or toxoid, single or combination (must be used together with code 90473 if two or more vaccines administered).
96381	Respiratory syncytial virus, monoclonal antibody, seasonal dose; 1 ml dosage, for intramuscular use	Use the administration only for the RSV monoclonal antibody product for date of service on, or after, Jan. 1, 2024, without counseling if obtained through MnVFC.

Billing for Adult and Non MnVFC Vaccines

Bill for adult vaccines according to the following:

· Use the 837P or 837I MN–ITS transaction.

· Enter the appropriate vaccine code and vaccine administration code on the same claim (from the following table).

· Do not enter modifier SL with the vaccine code.

· Enter the usual and customary vaccine charge and administration charge for administering the vaccine.

· Use the following codes when counseling is not provided and when administering vaccines and toxoids is not available through MnVFC.

CPT Administration Code	Vaccine Administration Description	Use With
90471	Percutaneous, intradermal, subcutaneous, or intramuscular injections- 1 single or combination vaccine or toxoid	Use 90472 for each additional vaccine or toxoid, single or combination (must be used together with code 90471 if two or more vaccines administered) Do not use with 90473
90473	Intranasal or oral immunization administration- 1 single or combination vaccine or toxoid	Use 90474 for each additional vaccine or toxoid, single or combination (must be used together with code 90473 if two or more vaccines administered) Do not use with 90471
90480	Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (sars-cov2) (coronavirus disease [covid-19]) vaccine, single dose	Use the administration of vaccine only for COVID-19 vaccines (91304, 91320 and 91322). If, you provide vaccine counseling on the day you also administer the COVID-19 vaccine, you may not report counseling separately since code 90480 is valued to include counseling Do not report in conjunction with non-COVID-19 90476-90759 vaccines, toxoids.
G0008	Administration of Influenza vaccine	Bill with: 90630, 90653, 90654, 90655, 90656, 90657, 90658, 90672, 90673, 90674, 90682, 90685, 90686, 90687, 90688, Q2033, Q2034, Q2035, Q2036, Q2037, Q2038, Q2039 Use with: 90472, 90474
G0009	Administration of Pneumococcal vaccine	Bill with: 90669, 90670, 90732 Use with: 90472, 90474
G0010	Administration of Hepatitis B vaccine	Bill with: 90740, 90744, 90746, 90747 Use with: 90472, 90474

Payments are based on:

· The base rate for vaccine administration is the lower of the provider’s submitted charge or the resource based relative value scale (RBRVS) rate

· Medicare’s average sale price (ASP) plus six percent. The paid amount is not to exceed the Centers for Medicare and Medicaid Services (CMS) Minnesota maximum vaccine administration fee or

· The wholesale acquisition cost if Medicare has not established an ASP

Legal References

Minnesota Statutes, 150A.055 (Administration of Vaccines)
Minnesota Statutes, 151.01, subdivision 27 (Practice of pharmacy - allows administration of flu vaccines to children)
Minnesota Statutes, 256B.0625, subdivisions 39 and 60 (Covered Services - Childhood immunizations; Community paramedic services)