OAR 410-121-0185
Pharmacy Based Immunization Delivery

(1)

Pursuant to ORS 689.645 (Vaccines, patient care services, drugs and devices) and the Board of Pharmacy administrative rules 855-019-0270 (Immunization Qualifications) through 855-019-0290 (Immunization Record Keeping and Reporting), pharmacists may prescribe and administer vaccines to persons who are at least seven years of age.

(2)

To receive reimbursement for vaccine administration and serum for adults (ages 19 and older), the pharmacy may bill either:
(a) Through Point-of-Sale (POS) using the appropriate National Drug Code (NDC) for the serum, and the administration fee shall automatically be applied equivalent to Current Procedural Terminology (CPT) codes 90470-90474 ; or

(b)

Bill on a CMS-1500, OHP 505, or Provider Web Portal professional claim using the appropriate immunization CPT code for the serum; or

(c)

Bill as a Provider Web Portal pharmacy claim.

(3)

If billing as a professional claim, the pharmacy must include:

(a)

A primary diagnosis to the highest degree of specificity;

(b)

The appropriate CPT code for the serum, code ranges 90476-90749; and

(c)

The appropriate CPT code for the administration, code ranges 90470-90474.

(4)

Vaccines for Children (VFC) is a federal program that provides vaccine serums at no cost to providers for patients under age 19. All vaccines for this age group and for conditions covered by the VFC program must be obtained through the VFC program. For information about the VFC program or to enroll as a VFC provider, contact the Public Health Immunization Program. The Oregon VFC program website is located at http:/­/­public.health.oregon.gov/­PreventionWellness/­VaccinesImmunization/­ImmunizationProviderResources/­vfc/­Pages/­index.aspx.

(5)

The Division shall reimburse only for the administration, not the serum, of vaccines available for free through the VFC program. For a list of vaccines provided through the VFC program, see the current Oregon Immunization Program State-Supplied Vaccine Billing Codes table available at http://bit.ly/1c3T6zy.

(6)

To receive reimbursement for vaccine administration to a child age 7 through 18, the pharmacy must:

(a)

Be enrolled as a pharmacy provider in the VFC program;

(b)

Bill on a CMS-1500, OHP 505, or Provider Web Portal professional claim;

(c)

Use the appropriate immunization CPT code for the serum; and

(d)

Include the appropriate modifier –SL or -26;

(7)

For detailed information on billing for the VFC Program, refer to Medical Surgical Services OAR 410-130-0255 (Immunizations, Vaccines for Children, and Immune Globulins).

Source: Rule 410-121-0185 — Pharmacy Based Immunization Delivery, https://secure.­sos.­state.­or.­us/oard/view.­action?ruleNumber=410-121-0185.

410‑121‑0000
Foreword and Definition of Terms 410‑121‑0021
Organizations Authorized to Provide Pharmaceutical Prescription Services 410‑121‑0030
Practitioner-Managed Prescription Drug Plan 410‑121‑0032
Supplemental Rebate Agreements 410‑121‑0033
Polypharmacy Profiling 410‑121‑0040
Prior Authorization Required for Drugs and Products 410‑121‑0060
How to Get Prior Authorization for Drugs 410‑121‑0061
Durable Medical Equipment, Medical Supplies, and Medical Surgical Services (Physician Administered Drugs) 410‑121‑0100
Drug Use Review 410‑121‑0111
Pharmacy and Therapeutics Committee 410‑121‑0135
Pharmacy Management Program 410‑121‑0143
Client Confidentiality 410‑121‑0145
Prescription Requirements 410‑121‑0146
Dispensing Limitations 410‑121‑0147
Exclusions and Limitations 410‑121‑0148
Dispensing in a Nursing Facility or Community Based Care Living Facility 410‑121‑0150
Billing Requirements 410‑121‑0155
Reimbursement 410‑121‑0157
Participation in the Medicaid Drug Rebate Program 410‑121‑0160
Dispensing Fees 410‑121‑0185
Pharmacy Based Immunization Delivery 410‑121‑0190
Medication Therapy Management Services and Clozapine Therapy Monitoring 410‑121‑0200
Billing Forms 410‑121‑0220
Instructions for Completion of the Prescription Drug Invoice 410‑121‑0280
Billing Quantities, Metric Quantities and Package Sizes 410‑121‑0300
CMS Federal Upper Limits for Drug Payments 410‑121‑0420
DESI Less-Than-Effective Drug List 410‑121‑0580
Oregon Medicaid and Pharmaceutical Manufacturers’ Dispute Resolution Procedures 410‑121‑0625
Items Covered in the All-Inclusive Rate for Nursing Facilities
Last Updated

Jun. 8, 2021

Rule 410-121-0185’s source at or​.us