Billing Changes for Gardasil Vaccines

May 30, 2012

Starting 6/1/2012, the Centers for Disease Control (CDC) age guidelines for billing the Gardasil vaccine will be updated in MIHMS.

When appropriate, please use the SL modifier for State-supplied vaccine as indicated below: - For males and females ages 9-18 years, providers should bill 90649-SL with a zero charge. MaineCare will reimburse the admin charge 90471 based on the Usual, Customary, and Reasonable (UCR) fee schedule. - For males and females ages 19-20 years, providers should bill 90649 with your charge and without the SL modifier. This requires a Prior Authorization (PA) and documentation that the member started the series prior to turning 19.

  • Once the member turns 21 years of age, this service is no longer covered regardless of whether the member has completed the series of shots and/or if they have a PA in place.

If there are any questions about this change, please contact Provider Services at 1-800-321-5557.