MassHealth is enrolling and paying eligible local public health departments (LPHDs) and public school districts (PSDs) for purchasing and administering influenza (flu) and certain adult vaccines to eligible MassHealth members. The goal of this initiative is to provide MassHealth members with more access to flu and adult vaccines in public health settings and in geographic areas where MassHealth members have difficulty accessing vaccines.

Before enrolling in the MassHealth Flu and Adult Vaccine Program, LPHDs and PSDs must be enrolled on a calendar-year basis in the Massachusetts Department of Public Health (MDPH) Immunization Program. If you are a LPHD or PSD and not yet enrolled in MDPH’s Immunization Program for 2015, please enroll online via the Massachusetts Immunization Information System (MIIS) website or call 617-983-6828.

Providers should confirm eligibility for applying to this MassHealth program by calling 617-847-3130.

What Does MassHealth Cover for Flu Vaccines?

MassHealth pays for administration of flu vaccines when LPHDs and PSDs provide MDPH-supplied flu vaccines to eligible MassHealth members up to and including 18 years of age. In addition, MassHealth pays LPHDs for purchasing and administering flu vaccines for eligible MassHealth members 19 years of age and older. For more information, please see the “MassHealth Flu and Adult Vaccine Program Instructions – 2015-2016 pdf format of MassHealth Flu Vaccine Program Instructions
doc format of                             MassHealth Flu Vaccine Program Instructions                ” and the “Billing Instructions” section, below.

What Does MassHealth Cover for Adult Vaccines?

Eligible LPHDs enrolled in both the MDPH Immunization Program and this MassHealth program may receive payment for purchasing and administering adult vaccines to eligible MassHealth members 19 years of age and older. MassHealth will cover the following adult vaccines recommended by the U.S. Centers for Disease Control’s Advisory Committee on Immunization Practices (ACIP): hepatitis A; hepatitis B; hepatitis A and hepatitis B (HepA-HepB); human papilloma virus (HPV); measles, mumps, and rubella (MMR); meningococcal conjugate; meningococcal polysaccharide; pneumococcal conjugate; pneumococcal polysaccharide; tetanus toxoid adsorbed; tetanus and diphtheria toxoids, and acellular pertussis (Tdap); varicella; and zoster (shingles).

MassHealth encourages LPHDs to provide the above-approved adult vaccines to eligible MassHealth members 19 years of age and older. For more information, please see the “MassHealth Flu and Adult Vaccine Program Instructions – 2015-2016 pdf format of MassHealth Flu Vaccine Program Instructions
doc format of                             MassHealth Flu Vaccine Program Instructions                ” and the “Billing Instructions” section, below.

Program Instructions on COMMBUYS

The following document, which describes this MassHealth program in more detail, is posted on the Commonwealth’s electronic procurement system website, COMMBUYS, “MassHealth Flu and Adult Vaccine Program Instructions – 2015-2016 pdf format of MassHealth Flu Vaccine Program Instructions
doc format of                             MassHealth Flu Vaccine Program Instructions                .”

How Cities and Towns Can Enroll

On an annual basis, typically in August, MassHealth e-mails enrollment and informational packets to LPHDs and PSDs that participate in the MDPH Immunization Program. However, providers are responsible for monitoring COMMBUYS and this website.

To enroll in the MassHealth Flu and Adult Vaccine Program, eligible LPHDs and PSDs must complete, sign, and submit all applicable documents in the e-mailed MassHealth program enrollment packet. If your LPHD or PSD is enrolled in the MDPH Immunization Program and did not receive an enrollment packet by September 1, please contact MassHealth at 617-847-3130.

Note: LPHDs already enrolled in the flu component of the program should contact 617-847-3130 to obtain a copy of the Amended and Restated MassHealth Flu and Adult Vaccine Program Provider Contract. To receive payments for purchasing and administering adult vaccines, your LPHD must first be actively enrolled in the MDPH Immunization Program and then go through the enrollment process for the MassHealth program as outlined above.

Enrollment Materials

Note: LPHDs must have the municipality’s treasurer sign the Massachusetts Substitute W-9 (MA-W-9) and the Electronic Funds Transfer (EFT-1) forms. PSDs must have a school administrator with financial authority for the school system sign the MA-W-9 and the EFT-1 forms.

Included in the enrollment packets and posted on COMMBUYS  is a “MassHealth Flu and Adult Vaccine Program Provider Application Checklist pdf format of app-flu-v-check
rtf format of                             app-flu-v-check                ” to help ensure that your LPHD or PSD is submitting all of the required enrollment documents.

MassHealth offers technical support with the completion of the eight required enrollment documents. MassHealth strongly encourages that your LPHD or PSD contact the MassHealth Customer Service Center to help ensure that your application materials are completed correctly prior to submission.

Tel: 1-800-841-2900 / TTY: 1-800-497-4648 for persons who are deaf, hard of hearing, or speech disabled. 
Ask for the MassHealth Flu and Adult Vaccine Program specialist.
Hours: Monday–Friday, 8:00 a.m.–5:00 p.m.

Completed and signed enrollment packets should be sent to the following address.

MassHealth Customer Service Center
Attn: Provider Enrollment and Credentialing
P.O. Box 9162
Canton, MA 02021

Note: MassHealth will not pay for services provided before the date of the approved and signed contract.

Note: Once an LPHD or a PSD is enrolled in the respective component of the MassHealth Flu and Adult Vaccine Program, it does not need to renew its Provider Contract with MassHealth unless otherwise instructed by MassHealth. However, in order to maintain eligibility, the LPHD and/or PSD must re-enroll on a calendar-year basis in the MDPH Immunization Program.

Billing Instructions

MassHealth Flu Vaccine Component

LPHDs and PSDs enrolled in the MDPH Immunization Program receive state-supplied flu vaccine from MDPH at no cost for children up to and including 18 years of age. If an LPHD or a PSD is using state-supplied vaccine, it should not submit a claim for the vaccine’s cost to MassHealth or to a MassHealth managed care organization (MCO) as the claim will be denied. For patients 19 years of age and older, LPHDs and PSDs may receive payment for purchasing and administration of flu vaccines at fee-for-service rates. MassHealth will not pay for a MassHealth member enrolled in an MCO―such claims must be submitted to the respective MCO.

MassHealth Adult Vaccine Component

When LPHDs purchase adult vaccines for patients 19 years of age and older, MassHealth will pay the LPHDs for purchasing and administering the vaccines at fee-for-service rates. MassHealth will not pay for a MassHealth member enrolled in an MCO―such claims must be submitted to the respective MCOs.

  1. A number of administration procedure codes are now age-based.
  2. When the vaccine is MDPH-supplied, there may be a difference in the payment rates. Please use the “SL” modifier.
  3. Flu vaccine code 90686 (age 19+) will be reimbursed based on “individual consideration” (I.C.), i.e., payment will be based on the manufacturer’s invoice indicating the exact number of doses and price per dose (MassHealth will cover the cost for properly submitted invoices only).

When submitting a claim for vaccine services, LPHDs and PSDs should provide MassHealth members with a document to share with their primary care physician that includes their MassHealth ID and type of coverage, their name and date of birth, and their vaccine(s) and date(s) of service.

LPHDs and PSDs can submit claims to MassHealth using the following.

Note: Providers must submit claims to MassHealth within 90 days of the service date. Providers that choose to use a billing vendor should ensure that the vendor submits the provider’s claims on a timely basis.

Questions about the MassHealth Flu and Adult Vaccine Program?

If you have any questions about the MassHealth Flu and Adult Vaccine Program enrollment documents, please call 617-847-3130. If you have any questions about the MassHealth program’s coverage or claims submission procedures, please contact the MassHealth Customer Service Center at 1-800-841-2900 / TTY: 1-800-497-4648, for persons who are deaf, hard of hearing, or speech disabled. Hours: Monday–Friday, 8:00 a.m.–5:00 p.m.

Questions about the MDPH Vaccine Programs?

If you have clinical questions about vaccines or vaccine-preventable diseases, please call the MDPH Epidemiology and Immunization Unit at 617-983-6800.


This information is provided by MassHealth.