BILLING VACCINES FOR MEDIKIDS (TITLE XXI) MediKids is a Children’s Health Insurance Program (CHIP) for children ages one through four. Children enrolled in CHIP are not eligible to receive vaccines through the Vaccines for Children program. Providers will need to use vaccines from their private stock. Children eligible for the MediKids program must be enrolled in a Medicaid Managed Medical Assistance Plan. Occasionally, a child may be temporarily enrolled in fee-for-service. The child’s managed care enrollment will determine the way the provider bills for immunization services. MediKids children enrolled in a Medicaid Managed Medical Assistance Plan: • • Bill Medicaid for the vaccine product using the appropriate Current Procedural Terminology (CPT®) code on a CMS-1500 claim form. Bill the Medicaid Managed Medical Assistance Plan (follow billing instructions from the plan) for the service of administering the vaccine. MediKids children with Fee-for-Service • Bill Medicaid using the CMS-1500 claim form. Include the appropriate CPT® vaccine product code. The fee for the product code includes reimbursement for the administration of the vaccine. Vaccine Codes Vaccine codes and fees for MediKids can be found on the Agency’s website at: http://ahca.myflorida.com/Medicaid/MediKids/publications.shtml. Under “Vaccine Billing Instructions and Current Codes and Fees,” you will find the following: 1. Title XXI HMO Immunization Codes – These are the codes and fees to use when a MediKids child is assigned to a managed care plan. These fees are to reimburse for the vaccine. 2. Title XXI CHIP Immunization Codes - These are the codes and fees to use when a MediKids child is assigned to Fee-for-Service. These fees include reimbursement for both the vaccine product and administration of the vaccine. If you are unsure if a child has MediKids coverage, look at the benefit plan when checking eligibility for the month. The benefit plan for MediKids is MKIDS. Also, the MediKids aid categories are MKA, MKB or MKC. Please refer to the Medicaid Reimbursement Handbook CMS-1500 for instructions on how to submit claims to Medicaid. Revised July 14, 2014