What is Modifier SL in Medical Billing?

Vaccinating children is a vital responsibility. It prevents them from harmful diseases that may develop later on. Oftentimes, the vaccines are provided to healthcare providers by the state at no cost. According to the CDC’s vaccination coverage data, approximately 50% of children between 6 months and 17 years receive influenza vaccines annually. These vaccines are provided by the government.

However, a common question that medical billers ask is “How do we bill the administration services if the vaccine is state-supplied?” Well, the answer to this is modifier SL. 

We have created this guide to help you understand what this modifier is and how you can use it effectively in your billing. So, let’s start. 

Modifier SL – Description

The SL modifier stands for “State-Supplied Vaccine”. The meaning is simple, but its usage is not. So, let’s break this down in more detail.

When you administer a vaccine that is given to you by state subsidy, under programs like the Vaccines for Children Program (VFC), you must append this modifier to your claim.

The important thing to note here is that you must append the SL modifier to the CPT code of the vaccine and not the administration codes. This indicates that while the vaccine itself was free, the provider should still be reimbursed for administration services.

Appropriate Use Cases for Modifier SL

To clear any remaining confusion, let’s look at a couple of real-world scenarios in which this modifier can be used:

Administration of Influenza Vaccine

Suppose a 7-year-old child is brought to your practice to get his annual flu shot during flu season. You received the vaccine at no cost via the VFC program, so there is no need to bill it. However, you can still bill for the vaccine injection service itself.

So, in this case, you can append modifier SL to the influenza vaccine code (CPT code 90688) and charge $0.00. Additionally, you can bill CPT code 90460 (immunization administration to patients 18 years of age or younger) for the appropriate administration fee.  

Hepatitis B Vaccine

One of the most common diseases that requires vaccination is hepatitis B. Healthcare providers can bill hepatitis B vaccination services to adults with high risks of liver disease. Suppose an uninsured 45-year-old obese man visits a community health center for a routine checkup. During the checkup, the physician diagnoses a fatty liver, which could worsen in case of a hepatitis attack.

So, he administers the state-provided vaccine for hepatitis B and provides the necessary medications to treat the fatty liver. In this case, the physician can bill for the immunization services via a relevant CPT code and by appending modifier SL to the vaccine code.

Accurate Usage Guidelines for Modifier SL

To prevent claim denials and get fair reimbursement for your services, you should follow the guidelines below:

• Never append modifier SL to the service code. SL should be appended to the vaccine code only.
• Documentation is extremely essential if you want your claims to be accepted. You must maintain records showing that vaccines were indeed obtained at no cost from state or federal sources.
• Make sure to bill the vaccine product and administration codes on the same claim form whenever possible.
• In some cases, you might have to use other modifiers in your claims alongside SL. For instance, for high-risk patients, some insurance payers require both modifier SL and SK.

Final Thoughts

Modifier SL is an important code to get reimbursement for your services when the vaccine itself has no cost. The essence of everything that we discussed in this guide is that SL should be appended to the vaccine code, and not the administration code. 

We hope that this guide has cleared all your confusion about this modifier. However, if you are having problems with your medical billing and coding, our experts are just a call away. 

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