MedicaidBilling CodesHigh impact
[New York] Vaccines for Children
Anthem BCBS·NY · Pediatrics, Family Medicine, General Practice·Provider Bulletin
Effective date
Jul 1, 2026
We identified it
Jul 2, 2026
Summary
Anthem Blue Cross Blue Shield (New York Medicaid) is clarifying VFC (Vaccines for Children) program billing requirements, effective July 1, 2026. All VFC claims must now include vaccine serum code(s), appropriate vaccine administration code(s), and required modifier code(s)—even though serum is provided at no cost and not separately reimbursable. Claims missing these required components will be denied and ineligible for reimbursement.
Action Required
By July 1, 2026: Billing team must audit and update VFC claim submission processes to ensure ALL claims include: (1) vaccine serum code(s), (2) vaccine administration code(s), and (3) applicable modifier code(s). Update billing software validation rules to require these three components before claim submission. Train all billing staff and providers on the new requirement that serum codes must be included for reporting and documentation purposes, even though serum is not separately reimbursable. Review encounter forms and EMR templates to ensure providers document administered vaccines with complete code information. Implement pre-submission quality checks to catch incomplete claims before transmission to Anthem. Failure to include all required codes will result in claim denials and delayed reimbursement. No balance billing is permitted for these VFC requirements.