MedicaidCoverageHigh impact
[Virginia] Discontinuation of payment for two immunization administration fees
Anthem BCBS·VA · Allergy & Immunology, Family Medicine, General Practice +2 more·Claims & Billing
Effective date
May 1, 2026
We identified it
May 3, 2026
Summary
HealthKeepers, Inc. (Medicaid Virginia) is discontinuing payment for immunization administration codes 90460 and 90461 effective May 1, 2026. Billing teams must remove these codes from the fee schedule and redirect claims to alternative administration codes, as serum/vaccine codes remain unaffected.
Action Required
By April 30, 2026: Billing team must update billing system to discontinue payment processing for CPT 90460 (immunization admin first dose) and CPT 90461 (immunization admin each additional component) for HealthKeepers, Inc. Medicaid claims. Remove these codes from the active fee schedule and update claim submission rules to deny or redirect claims using these codes received on or after May 1, 2026. Audit pending claims using these codes before the effective date to ensure timely reimbursement. Notify clinical staff that immunization administration must use alternative approved administration codes moving forward. Communicate with providers that vaccine/serum codes remain payable—only administration fees are affected. Failure to implement this change will result in claim denials for services billed under these codes.