MedicaidCoverageHigh impact
[Virginia] Discontinuation of payment for immunization administration fees
Anthem BCBS·VA · Pediatrics, Family Medicine, Internal Medicine +2 more·Claims & Billing
Effective date
Jun 1, 2026
We identified it
May 3, 2026
Summary
Effective June 1, 2026, HealthKeepers, Inc. (Medicaid in Virginia) will discontinue payment for immunization administration fees for CPT codes 90471, 90472, 90473, and 90474. The practice must stop billing these codes to this payer and implement claim rejection protocols to prevent denials and revenue loss.
Action Required
By May 31, 2026: Billing team must update all billing software, claims submission rules, and fee schedules to remove or zero-price CPT 90471, 90472, 90473, and 90474 for HealthKeepers Inc./Virginia Medicaid claims. Front desk staff should flag any encounter forms or templates that auto-populate these codes for immunization visits. Providers must be notified that immunization administration will not be reimbursable under this plan effective June 1, 2026. Implement a claims audit process to catch and reject any claims submitted with these codes to HealthKeepers after the effective date. Failure to stop billing these codes will result in claim denials and potential overpayment recovery demands. Note: Vaccine serum codes and all other administration codes remain unaffected.