All PlansBilling CodesMedium impact
PAP505 - Immunization Billing - Updated coding guidance
Blue Cross of Idaho·ID · Family Medicine, Pediatrics, Internal Medicine +1 more·Coding
We identified it
Jun 19, 2026
Summary
Blue Cross of Idaho updated immunization billing guidance, clarifying that vaccines from universal vaccine programs for ages 0-18 are not reimbursed, but administration fees are covered. Providers must use modifier SL with $0.00 charge for supplied vaccines and follow specific CPT coding rules for single vs. multiple immunization encounters.
Action Required
Immediately: Update billing procedures for immunizations - bill vaccine administration with modifier SL and $0.00 charge for universal program vaccines (ages 0-18). Use only one initial immunization administration CPT code per encounter, then appropriate secondary codes for additional immunizations. Update billing system rules and staff training on universal vaccine program identification.