MedicaidBilling CodesHigh impact
[Ohio] Vaccine for Children Program Administration Billing Guidance
CareSource·OH · Pediatrics, Family Medicine, General Practice +1 more·Claims & Billing
Effective date
Jul 1, 2026
We identified it
May 30, 2026
Summary
Effective July 1, 2026, CareSource will reject vaccine administration claims billed with CPT codes 90471 or 90472 for VFC-covered toxoids when the provider is part of the VFC program. VFC providers must use CPT code 90460 instead for vaccine administration of covered toxoids.
Action Required
By June 30, 2026: Billing team must update billing system configuration to mandate use of CPT 90460 (instead of CPT 90471 or 90472) for vaccine administration when billing VFC-covered toxoids to CareSource Ohio Medicaid for providers enrolled in the VFC program. Configure system to flag or auto-correct claims using 90471 or 90472 with any of the listed toxoid codes (90380-90382, 90584, 90611, 90619-90634, 90644-90690, 90694-90744, 90759, 91318-91322) to prevent denials. Notify all clinical staff and providers at VFC-participating locations of the code change requirement. Update encounter templates or vaccine administration forms to reflect the new code requirement. Failure to implement this change will result in claim denials effective July 1, 2026. Contact CareSource Provider Services at 1-800-488-0134 for questions.