(928) 779-2113
Vaccines for Children (VFC) Program
All Capstone Members under the age of 18 are Medicaid recipients and qualify for the use of state funded vaccinations. The following codes are covered under the VFC program and must be billed using the SL modifier.
| 90633 | Hepatitis A vaccine, pediatric/adolescent dosage-2dose schedule |
| 90647 | Hemophilus influenza b vaccine (Hib), PRP-OMP conjugate (3 dose schedule) |
| 90648 | Hemophilus influenza b vaccine (Hib), PRP-T conjugate (4 dose schedule) |
| 90649 | HPV - Human Papillomanvirus |
| 90655 | Influenza virus vaccine, split virus, preservative, for children 6-35 months of age, for intramuscular use |
| 90656 | Influenza virus vaccine, split virus, preservative, for use in individuals 3 years and above, for intramuscular use |
| 90657 | Influenza virus vaccine, split virus, 6-35 months dosage (covered under VFC only for high-risk children) |
| 90658 | Influenza virus vaccine, split virus, 3 years and above (covered under VFC only for high-risk children) |
| 90660 | Influenza virus vaccine, live, for intranasal use |
| 90669 | Pneumococcal conjugate vaccine, polyvalent, for children under 5 years |
| 90680 | Rotavirus vaccine, pentavalent, 3 dose schedule, live for oral use |
| 90700 | Diphtheria, tetanus toxoids, and acellular pertussis (DTaP) |
| 90702 | Diphtheria and tetanus toxoids (DT) absorbed |
| 90707 | Measles, mumps and rubella virus vaccine (MMR) |
| 90710 | Measles, mumps, rubella, and varicella vaccine (MMRV), live for subcutaneous use |
| 90713 | Poliovirus vaccine, inactivated (IPV) |
| 90714 | Tetanus and diphtheria toxoids (Td) absorbed, preservative free, 7 years or older, IM |
| 90715 | Tetanus, diphtheria toxoids and acellular pertussis vaccine (Tdap), 10 years or older, IM |
| 90716 | Varicella virus vaccine, live |
| 90723 | Diphtheria, tetanus toxoids, acellular pertussis vaccine, Hepatitis B, and poliovirus vaccine, inactivated (DtaP-HepB-IPV) |
| 90732 | Pneumococcal polysaccharide, 23 valent |
| 90734 | Meningococcal conjugate vaccine, serogroups A, C, and Y and W-135 (tetravalent), for IM use |
| 90743 | Hepatitis B vaccine, adolescent (2 dose schedule) |
| 90744 | Hepatitis B vaccine, pediatric/adolescent dosage (3 dose schedule) |
| 90748 | Hepatitis B and Hemophilus influenza b (HepB-Hib) |
