Covered Services

Seasonal Influenza Vaccines

Seasonal influenza (flu) vaccine is a covered service for PrimeWest Health members. Providers must obtain their seasonal flu vaccine supply to be administered to PrimeWest Health members age 18 and under from the Minnesota Vaccines for Children Program (MnVFC) program. For PrimeWest Health-enrolled adults age 19 and over, seasonal flu vaccine is covered by PrimeWest Health.

MnVFC seasonal flu vaccines are distributed in the fall and are administered throughout the flu season. Annual seasonal flu vaccine distribution and reimbursement updates from the Minnesota Department of Health (MDH) and the Minnesota Department of Human Services (DHS) are released in the fall. The annual supply of flu vaccine, and the timing of its distribution, cannot be guaranteed in any year. When MnVFC seasonal flu vaccines are not available, refer to the MDH Immunization Information for Health Care Providers web page for the latest information on seasonal influenza coverage.

• For more information on Minnesota’s Influenza Vaccination Plan for the current season and a current list of all vaccines available through MnVFC, refer to the MDH MnVFC web page.
• Refer to Seasonal Flu Vaccine Billing Codes for the current year’s information

When billing for seasonal flu vaccines, please note the following:

• Bill the vaccine’s administration code in addition to the vaccine code. When giving MnVFC vaccines, bill the code for the vaccine with modifier SL. PrimeWest Health will reimburse providers the prevailing fee schedule rate for the administration fee for each single or combination MnVFC vaccine administered.
• For members age 19 and over, PrimeWest Health pays the vaccine fee schedule rate plus the prevailing fee schedule rate for the non-MnVFC administration fee. Bill the appropriate administration and vaccine codes; do not use the SL modifier.

*Not available through MnVFC

Other Vaccines/Vaccine Administration Codes

Obtain the available vaccines for MnVFC-eligible members from MDH. The program supplies vaccines at no cost to participating providers. PrimeWest Health will reimburse providers only for the administration of MnVFC vaccines. Please note the following:

• Federal legislation limits the amount a MnVFC participating provider may charge for administering a vaccine to a child
• PrimeWest Health will reimburse providers the prevailing fee schedule rate for the administration fee for each single or combination MnVFC vaccine administered
• PrimeWest Health does not pay for purchase of vaccines available through MnVFC

For a current list of vaccines available through MnVFC, refer to the MDH MnVFC web page or call the Immunization Program at 1-651-201-5503 or 1-800-657-3970 (toll free). The list of available MnVFC vaccines can be found on the vaccine order form, which is accessible online.

For vaccines not available through MnVFC, payment to providers for vaccine procedure codes is based on the vaccine fee schedule rate plus the prevailing fee schedule rate for the non-MnVFC administration fee. Please note the following:

• Vaccination reimbursement rates are updated regularly as wholesale prices change
• When billing for a non-MnVFC-supplied vaccine, follow the same instructions as billing for MnVFC vaccines, except do not use the SL modifier

Administration of vaccines and toxoids to MHCP-enrolled infants, children, and adults is a covered service. All vaccines that are available through the MnVFC program must be obtained from MDH. Most routine childhood vaccines are available through the MnVFC program.

• For more information about which vaccines are covered by MHCP, refer to the DHS Immunization and Vaccine Benefits Codes for Children.
• Refer to the Immunization and Vaccination section in Children's Services for immunization requirements and schedules.

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Updated_02/27/2025