Policy Application
All claims submitted for this policy will be processed according to the policy effective date and associated revision effective dates in effect on the date of processing, regardless of service date.
Policy:
Blue Cross Blue Shield of North Dakota (BCBSND) does not reimburse for vaccine(s) obtained at no cost to the provider. Modifier SL must be used to identify the vaccine(s) was obtained at no cost to the provider. BCBSND will reimburse for the administration of the vaccine(s) in accordance with the patient’s benefit coverage. Administration codes include vaccine risk/benefit counseling when performed. Therefore, a separate Evaluation and Management (E/M) code should not be reported, unless performed as a separately identifiable service distinct from the vaccine administration and documented in the medical records. E/M services submitted as separately identifiable and distinct from the administration service should be reported with modifier 25 appended to the line.
