Vaccine Coverage Update and Important Reminder for Seasonal Vaccines

This year’s seasonal vaccine update highlights expanded ForwardHealth coverage for the mFLUSIVA mRNA influenza vaccine as well as information about:

• Influenza and COVID-19 vaccines for children.
• Influenza and COVID-19 vaccines for adults.
• Non-Vaccines for Children (VFC) pharmacy provider influenza and COVID-19 vaccines for children.

Vaccine Coverage Update for Providers

Starting September 1, 2026, ForwardHealth added coverage of the mRNA influenza vaccine mFLUSIVA for members age 50 years and older as detailed in this table.

Reimbursement rates for all vaccine-related procedure codes are listed on the maximum allowable fee schedules on the ForwardHealth Portal.

Influenza and COVID-19 Vaccines for Children

Influenza and COVID-19 vaccines are part of the VFC program. VFC-enrolled providers must obtain and use VFC vaccine stock for VFC-eligible members with Medicaid coverage.

As a reminder:

• Providers must use an SL modifier (State-supplied vaccine) on the claim detail for the vaccine product provided through VFC.
• ForwardHealth does not reimburse for vaccine products supplied by the VFC program. 

Influenza and COVID-19 Vaccines for Adults

For members 19 years of age and older, ForwardHealth reimburses providers for both the vaccine product and vaccine administration.

Non-Vaccines for Children Pharmacy Provider Influenza and COVID-19 Vaccines for Children

Non-VFC pharmacy providers who administer influenza and COVID-19 vaccines to Medicaid-eligible children will be reimbursed for both the vaccine product and vaccine administration.

Note: ForwardHealth is authorized to reimburse non-VFC pharmacies providing influenza and COVID-19 vaccines until December 31, 2029, per the Public Readiness and Emergency Preparedness (PREP) Act.

Important Vaccine Policy Reminders

• Pharmacy providers must submit a fee-for-service professional claim to ForwardHealth if the member receiving the vaccine is enrolled in a BadgerCare Plus or SSI HMO. (BadgerCare Plus and SSI HMOs can’t accept claims for vaccines from pharmacy providers.)
• Pharmacy providers may not submit compound or non-compound drug claims using national drug codes, as these claims will be denied.
• Medical providers should bill vaccines to the member’s managed care organization if a member is enrolled in a BadgerCare Plus or SSI HMO.
• Members do not have any out-of-pocket expenses for vaccines. Refer to the ForwardHealth Online Handbook Member Payment for Covered Services topic #86 for more information.
• All providers must enter vaccines for all members into the Wisconsin Immunization Registry (WIR) within seven days of administering the vaccine. For more information, refer to the WIR website.

Online Handbook Topics

• Vaccines topic #12457
• Immunizations and Vaccines topic #503
• Vaccines for Children Program topic #3545
• Member Payment for Covered Services topic #86

Additional Resources

• Immunizations: Vaccines for Children Program Information for Parents and Patients About the Vaccines for Children (VFC) Program
• Immunization Program
• Immunizations: Recommended Vaccination Schedules for Wisconsinites
• DPH Communicable Diseases Memos