I am in Florida. Medicaid has all different HMO's all requiring slightly different variations, but this is the way we do it:
For insurance patients some use a modifier for the well child cpt code (25) and some do not. For the vaccine codes the first line with the vaccine cpt is the cost of the vaccine and the second line for the vaccine is 90460 (usually we put a cost of 40.00). If the vaccine has more than one component the third line of below the vaccine will be 90461 (usually we use a charge of 40.00) and the number of units will vary.For MMRV it will be 3 units since the first unit was charged with the 90460.

Your scenario above will look like this
99393 25(modifier) 150.00Charge) 1(unit) 150.00(total charge)
90710 200.00 1 85
90460 40.00 1 40
90461 40.00 3 120
90700 35.00 1 35
90460 40.00 1 40
90461 40.00 2 80
90713 45.00 1 45
90460 40.00 1 40

In florida for straight medicaid we can only bill for the vaccine cpt code and only get reimbursed 10.00 (we have to use VFC vaccines) and we can only 90460 for which you get a few dollars(cannot bill 90461 no matter how many vaccine components)


Kinda longwinded explanation, hope it helps.

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Raj
From (mostly) sunny Port St Lucie, florida