Eligibility Screening and Documentation
At each immunization encounter, VFC providers are required to screen patients and document eligibility status for patients eligible for publicly-funded vaccine. Providers may use their practice's paper or electronic system to document eligibility, but must also enter eligibility status for each dose administered into NYSIIS for patients eligible for publicly-funded vaccine. See Patient Eligibility for Publicly-Funded Vaccines (PDF)
Vaccine Administration Fees
VFC providers must immunize children eligible for publicly-funded vaccine (VFC, CHP, State) at no charge to the patient for the cost of the vaccine. VFC providers may be able to receive an office visit fee and a vaccine administration fee, depending on the eligibility category through which children qualify for the program. VFC providers must not deny administration of publicly-funded vaccines to any eligible child due to the inability of the child's parent or guardian to pay the vaccine administration fee. If the parent or guardian cannot pay the administration fee for a VFC vaccine, the provider must waive the administration fee. Health care providers must not refer Medicaid and CHP members to other sites, such as public health clinics, for their vaccines. Health care providers who inappropriately refer patients or attempt to force collection of administration fees from patients will be prohibited from participating in the Medicaid and CHIP programs.
Maximum Reimbursement by Eligibility Category: Vaccine Administration Fees
- Medicaid Fee-For-Service $25.10
- Medicaid Managed Care per contractual agreement with managed care company
- CHP (Child Health Plus) per contractual agreement with managed care company
- Uninsured $25.10
- Underinsured $25.10
- American Indian/Alaskan Native $25.10
