MedicaidBilling CodesHigh impact
ForwardHealth Update 2025-26: ForwardHealth Vaccine Coverage: New Sources of Vaccine Recommendations and Revised Billing for COVID-19, Influenza, and Measles, Mumps, Rubella, and Varicella VaccinesDecember 2, 2025: This Update has been revised since its original publication. Revised information appears in red text on page 3.
Wisconsin ForwardHealth·WI · Family Medicine, Internal Medicine, Pediatrics·Pharmacy
Effective date
Nov 1, 2025
We identified it
Jun 18, 2026
Summary
ForwardHealth (Wisconsin Medicaid) is expanding vaccine coverage beyond CDC recommendations and implementing new billing processes for COVID-19, influenza, and MMRV vaccines effective November 1, 2025. Claims for these vaccines submitted October 1-31 will be suspended and automatically processed November 1.
Action Required
By November 1, 2025: Update billing system for new COVID-19, influenza, and MMRV vaccine billing processes. Use specific vaccine product codes with administration code 90480. For VFC vaccines, add SL modifier to vaccine product code (not administration). Document VFC unavailability when using private stock for VFC-eligible members. Monitor suspended claims from October 1-31 for automatic processing.