MedicaidCoverageMedium impact
MAB2022030701
Pennsylvania Medicaid (DHS)·PA · Family Medicine, General Practice, Pediatrics +1 more·Provider Bulletin
Effective date
Oct 14, 2021
We identified it
Jun 20, 2026
Summary
Medical Assistance (Medicaid) in Pennsylvania has expanded coverage for Flucelvax Quadrivalent vaccine administration to include beneficiaries as young as 6 months old, previously limited to 4 years and older. Providers can now bill CPT codes 90674 and 90756 for vaccine administration in patients 6 months and older at $10.00 per administration.
Action Required
Immediately: Update billing system age restrictions for CPT codes 90674 and 90756 to allow billing for Flucelvax Quadrivalent vaccine administration in Medical Assistance beneficiaries aged 6 months and older. Verify system allows $10.00 reimbursement rate for each administration. For beneficiaries under 19, advise families to obtain vaccines through VFC Program providers when possible.