Or. Admin. R. 410-121-0185

Current through Register Vol. 63, No. 8, August 1, 2024

Section 410-121-0185 - Pharmacy Based Immunization Delivery

(1) Pursuant to ORS 689.645 and the Board of Pharmacy administrative rules 855-019-0270 through 855-019-0290, pharmacists may prescribe and administer vaccines to persons who are at least seven years of age.

(2) To receive reimbursement for vaccine administration and serum for adults (ages 19 and older), the pharmacy may bill either:

(a) Through Point-of-Sale (POS) using the appropriate National Drug Code (NDC) for the serum, and the administration fee shall automatically be applied equivalent to Current Procedural Terminology (CPT) codes 90470-90474 ; or

(b) Bill on a CMS-1500, OHP 505, or Provider Web Portal professional claim using the appropriate immunization CPT code for the serum; or

(c) Bill as a Provider Web Portal pharmacy claim.

(3) If billing as a professional claim, the pharmacy must include:

(a) A primary diagnosis to the highest degree of specificity;

(b) The appropriate CPT code for the serum, code ranges 90476-90749; and

(c) The appropriate CPT code for the administration, code ranges 90470-90474.

(4) Vaccines for Children (VFC) is a federal program that provides vaccine serums at no cost to providers for patients under age 19. All vaccines for this age group and for conditions covered by the VFC program must be obtained through the VFC program. For information about the VFC program or to enroll as a VFC provider, contact the Public Health Immunization Program. The Oregon VFC program website is located at http://public.health.oregon.gov/PreventionWellness/VaccinesImmunization/ImmunizationProviderResources/vfc/Pages/index.aspx.

(5) The Division shall reimburse only for the administration, not the serum, of vaccines available for free through the VFC program. For a list of vaccines provided through the VFC program, see the current Oregon Immunization Program State-Supplied Vaccine Billing Codes table available at http://bit.ly/1c3T6zy.

(6) To receive reimbursement for vaccine administration to a child age 7 through 18, the pharmacy must:

(a) Be enrolled as a pharmacy provider in the VFC program;

(b) Bill on a CMS-1500, OHP 505, or Provider Web Portal professional claim;

(c) Use the appropriate immunization CPT code for the serum; and

(d) Include the appropriate modifier -SL or -26;

(7) For detailed information on billing for the VFC Program, refer to Medical Surgical Services OAR 410-130-0255.

Or. Admin. R. 410-121-0185

OMAP 31-2001, f. 9-24-01, cert. ef. 10-1-01; OMAP 7-2002, f. & cert. ef. 4-1-02; OMAP 18-2004, f. 3-15-04 cert. ef. 4-1-04; OMAP 9-2005, f. 3-9-05, cert. ef. 4-1-05; DMAP 36-2008, f. 12-11-08, cert. ef. 1-1-09; DMAP 17-2010, f. 6-15-10, cert. ef. 7-1-10; DMAP 14-2011, f. 6-29-11, cert. ef. 7-1-11; DMAP 44-2011, f. 12-21-11, cert. ef. 1-1-12; DMAP 51-2015, f. 9-22-15, cert. ef. 10/1/2015; DMAP 11-2018, amend filed 03/02/2018, effective 3/2/2018

Statutory/Other Authority: ORS 413.042 & 414.065

Statutes/Other Implemented: ORS 414.065