MedicaidBilling CodesHigh impact
ForwardHealth Update 2026-01: ForwardHealth Expands Vaccine Billing Process Changes
Wisconsin ForwardHealth·WI · Family Medicine, Internal Medicine, General Practice +1 more·Pharmacy
Effective date
Feb 1, 2026
We identified it
Jun 18, 2026
Summary
ForwardHealth is expanding vaccine billing requirements effective February 1, 2026. All providers must now include both vaccine product codes AND administration codes on all vaccine claims, and must add the SL modifier for vaccines supplied through the federal Vaccines for Children (VFC) Program.
Action Required
By February 1, 2026: Billing team must update billing system to require BOTH vaccine product codes AND vaccine administration procedure codes on all vaccine claims. Add SL modifier requirement for all VFC-supplied vaccines (product codes only, not administration codes). Update encounter forms and staff training to ensure proper coding. Claims missing administration codes or SL modifiers will require resubmission for proper reimbursement.