ForwardHealth is reminding providers to use the appropriate modifier identified in ForwardHealth Update 2025-26, “ForwardHealth Vaccine Coverage: New Sources of Vaccine Recommendations and Revised Billing for COVID-19, Influenza, and Measles, Mumps, Rubella, and Varicella Vaccines,” when submitting claims for specific vaccines.
For the vaccines specified above, providers must indicate the appropriate vaccine product current procedural terminology (CPT) code on the claim detail and append the SL modifier when the vaccine was obtained through the Vaccines for Children (VFC) program. Providers do not need to include the SL modifier on the claim detail line with the administration CPT code.
Providers who submitted claims for these vaccines on or after October 1, 2025, that were VFC supplied without the SL modifier and were reimbursed incorrectly, should correct and rebill their claims.
Providers should refer to the maximum allowable fee schedule on the ForwardHealth Portal (the Portal) for more information about vaccine reimbursement rates. Providers should refer to the ForwardHealth Online Handbook Vaccine topic #12457, Immunizations and Vaccines topic #503, and Vaccines for Children Program topic #3545 for more information.
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