title: Financial impact to providers using pediatric combination vaccines.
abstract: OBJECTIVE
  To understand the financial impact to providers for using a combination vaccine (Pediarix [GlaxoSmithKline Biologicals, King of Prussia, PA]) versus its equivalent component vaccines for children aged 1 year or younger.
  
  
  METHODS
  Using a subscription remittance billing service offered to private-practice office-based physicians, we analyzed charge and payment information submitted by providers to insurance payers from June 2007 through July 2009. We analyzed provider and payer characteristics, payer comments, and the ratio of vaccine product to immunization administration (IA) codes and computed total charges and payments to providers for both arms of the study.
  
  
  RESULTS
  Most providers in our data set were pediatricians (74%), and most payers were commercial (75%), primarily managed care. The ratio of the number of vaccine products to the number of IAs was 1:1 in the majority of the claims. Twenty percent of claims were paid with no adjustment by the payer, whereas 76% of the claims were adjusted for charges that exceeded the contract arrangement or the fee schedule. Providers received $23 less from commercial payers and $13 less from Medicaid for the use of Pediarix compared with the equivalent component vaccines. The mean commercial payment was greater for age-specific Current Procedural Terminology IA codes 90465 and 90466 than for non-age-specific codes 90471 and 90472, whereas the reverse was true for Medicaid.
  
  
  CONCLUSIONS
  Providers who administer vaccines to children face a reduction in payment when choosing to provide combination vaccines. The new IA codes should be monitored for correction of financial barriers to the use of combination vaccines.
authors: National Vaccine Program Office, US Department of Health andHuman Services, Washington, DC, USA.
authors: Angela K
authors: AK
authors: Shen
authors: Elizabeth
authors: E
authors: Sobczyk
authors: Lone
authors: L
authors: Simonsen
authors: Farid
authors: F
authors: Khan
authors: Allahna
authors: A
authors: Esber
authors: Margie C
authors: MC
authors: Andreae
mesh_terms: D006801:Humans; D007223:Infant; D014481:United States; D014611:Vaccination / Q000191:economics*; D017778:Vaccines, Combined / Q000191:economics*
chemical_list: D017778:Vaccines, Combined