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.
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 Physician Subchapter 6.
Additional Resources
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.
How Cities and Towns Can Enroll
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 2018, please enroll online via the Massachusetts Immunization Information System (MIIS) website or call (617) 983-6828.
To enroll in the MassHealth program, call the MassHealth Customer Service Center at (800) 841-2900; TTY: (800) 497-4648, and ask to speak to a Flu and Adult Vaccine Program Specialist.
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.
To find the reimbursable vaccines, please review the Physician Subchapter 6.
Questions about the MassHealth Flu and Adult Vaccine Program?
If you have any questions about the MassHealth Flu and Adult Vaccine Program enrollment documents, program coverage, or claims submission procedures, please call the MassHealth Customer Service Center at (800) 841-2900; TTY: (800) 497-4648.
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. Please address all MassHealth-related questions to the MassHealth Customer Service Center.