Effective February 1, 2026, providers are required to include both the vaccine product and vaccine administration Current Procedural Terminology (CPT) codes on claim details for all vaccines.
Vaccine product provided through the Vaccines for Children (VFC) program requires the modifier SL (State supplied vaccine) on the claim detail for the vaccine product. Claim details for the administration of VFC vaccines do not require the SL modifier.
Members Aged 18 and Younger
Members Aged 19 and Older
Vaccines for Children-Supplied Vaccine
Non-Vaccines for Children-Supplied Vaccine
Vaccines for Adults
Applicable vaccine product code
Yes
Applicable vaccine administration code
SL modifier (indicating state-supplied vaccine)
If a provider does not follow the appropriate billing instructions (for example, missing the vaccine administration CPT code or SL modifier), they should resubmit their claim to ensure proper reimbursement.
Providers should refer to the maximum allowable fee schedule for vaccine product and vaccine administration reimbursement rates.
ForwardHealth Update 2026-01, “ForwardHealth Expands Vaccine Billing Process Changes.”
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