Wiki The Max a practice can charge Insurance for vaccines

[Robinhenry]

Where can I find data to support what we can charge a payer over and beyond what we pay for vaccines?
Thank you,

 

[thomas7331]

I’m not aware of any laws or regulations that limit what a provider can charge a payer. But if the provider is contracted with the payer, then you are usually required by the terms of the contract to accept their fee as payment in full, regardless of how much you charge.

 

[AmandaBriggs]

There may be some limits for pediatric patients if you participate in the Vaccines for Children program. Your state Medicaid agency would be able to provide you with guidance on that.

 

[amyjph]

It's going to depend on the payer and your provider contract. Agree with the above advice.
A provider could charge a thousand dollars as the fee on a claim but the reimbursement is still going to be the fee schedule/contracted amount.

https://www.cdc.gov/vaccines/programs/vfc/about/index.html#cost

https://www.cdc.gov/vaccines/programs/vfc/awardees/vaccine-management/price-list/index.html