MedicaidCoverageMedium impact
Clarification on Medicaid Coverage of Pediatric Vaccines
Maryland Medicaid·MD · Pediatrics, Family Medicine, General Practice +1 more·General Provider
Effective date
Sep 24, 2025
We identified it
Jun 20, 2026
Summary
Maryland Medicaid has updated pediatric vaccine coverage guidance following FDA and ACIP recommendations. COVID-19 vaccines for ages 6 months-18 years now require individual-based decision-making, and MMRV combination vaccine is now recommended for children 4+ years. MCOs will not cover combined MMRV costs for children under 4 years as long as separate MMR and Varicella vaccines remain available through VFC. Providers must continue using VFC processes and append the SE modifier to all VFC vaccine codes.
Action Required
Effective immediately (September 24, 2025): Billing team must ensure all vaccine administration claims continue to use the SE modifier appended to vaccine codes for VFC-provided vaccines. Providers administering pediatric vaccines must remain enrolled in the VFC program and maintain private vaccine stock for non-VFC immunizations. Clinical staff should refer to the MDH Childhood Immunization Schedule for appropriate vaccine dosing and timing. Update internal protocols to reflect that COVID-19 vaccination decisions for ages 6 months-18 years are now individual-based rather than age-determined. Do not bill MCOs for combined MMRV vaccine costs for children under 4 years old; ensure billing system reflects that separate MMR and Varicella vaccines should be billed instead when applicable. Contact mdh.healthchoiceprovider@maryland.gov with questions or member access concerns.