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Washington State Providers: Proper Use of the “SL” Modifier on Vaccination Claims

Thursday, June 6, 2019

In accordance with the Washington State Childhood Vaccine Program, providers in the state of Washington can receive vaccines at no cost from the Washington Vaccine Association (WVA) to give to patients each year. Rendering providers then submit two claims to health care plans and payers, including TRICARE, for reimbursement: one for the administration of the vaccine and one on behalf of WVA for the vaccine itself. In order to ensure WVA is properly reimbursed, please do not bill for the vaccine and the administration of the vaccine on the same claim. If your record-keeping practices require you include a line item for the vaccine on the same claim as the administration, you must include an “SL” modifier on the vaccine line to specify it’s a state-supplied vaccine. This will ensure you are not reimbursed in error for the vaccine and the vaccine claim billed on behalf of WVA does not deny as a duplicate. 

Health Net Federal Services, LLC (HNFS) recognizes WVA educates Washington state providers to not use the “SL” modifier on vaccine claims. Keep in mind, this only applies to the claim submitted on behalf of WVA for the vaccine. Providers must use the “SL” modifier when including vaccine charges on claims for administering the vaccine in order for claims to process correctly.  

Vaccine administration claim

  • Billed under the rendering provider’s National Provider Identifier (NPI)
  • Paid to the rendering provider
  • Should only include billing codes for administering the vaccine, the office visit and any other services rendered
  • Should not include billing codes for the actual vaccine(s), but if included, must have the “SL” modifier  

Vaccine claim

  • Billed under WVA’s NPI
  • Paid to WVA
  • Must only include the billing codes for the actual vaccine(s) without the “SL” modifier 

For the TRICARE West Region, submit both claims to HNFS. Find claims submission instructions on our Claims Submission page. 

We appreciate your cooperation with these guidelines.