MedicaidBilling CodesMedium impact
Fee-for-service point of sale billing for COVID-19 and flu immunizations provided to Oregon Health Plan (OHP)-eligible children
Oregon Health Plan·OR · Family Medicine, Pediatrics, General Practice·Provider
Effective date
Oct 20, 2021
We identified it
Jun 20, 2026
Summary
Oregon Health Plan now allows fee-for-service pharmacy point-of-sale billing for COVID-19 and flu immunizations for children ages 3-18, with specific billing codes and reimbursement rates. VFC enrollment is no longer required for OHP providers giving children's COVID-19 vaccines or OHP pharmacies providing flu vaccines during the public health emergency.
Action Required
Immediately: Billing team must update pharmacy billing procedures for Oregon Health Plan members to bill CCO or OHA directly for children's flu and COVID-19 immunizations. Configure billing system with specific NCPDP field values: Professional Service Code (440-E5) as 'MA', Service Clarification Code (452-DK) as '2' for first COVID dose or '6' for second dose, Incentive Amount (483-E3) as $17.67 for first flu administration ($8.72 for additional) or $40.00 for each COVID administration, and Basis of Cost (423-DN) as '15'. Bill administration only for COVID vaccines and VFC-supplied flu vaccines, or both administration and serum for non-VFC flu vaccines.