State Supplied Vaccines

Immunization services are allowed in accordance with the Preventive Care Guidelines found on the Blue Cross and Blue Shield of North Carolina (Blue Cross NC) internet site (www.bcbsnc.com) and the member’s certificate benefits.  Blue Cross NC previously asked providers to file state-supplied vaccines with modifier 52 at $0 charge. Effective January 1, 2022, Blue Cross NC is updating guidance to use SL modifier on state-supplied vaccines at $0 charge in our immunizations reimbursement policy (PDF). SL modifier is defined as "State supplied vaccine." 

Key Reimbursement Guidelines 

• Immunizations are covered when the certificate includes benefits for immunizations.  
• Unless specifically excluded by a member’s contract, Blue Cross NC will allow coverage for new vaccines formally recommended by any of the following: the US Preventative Services Task Force; the American Academy of Pediatrics; and the Advisory Committee on Immunization Practices. 
• The actual administration of state-supplied vaccines will continue to be reimbursed through vaccine administration codes (90460-90474). 

These reimbursement requirements apply to all commercial, Administrative Services Only (ASO), Federal Employee Program (FEP) and Blue Card Inter-Plan Program Host members (other plans members who seek care from the NC service area). This policy does not apply to Blue Cross NC members who seek care in other states.