Meningococcal [Groups A, C, Y, W] Conjugate Vaccine, Solution for Intramuscular Injection (MenQuadfi™) CPT Code 90619: Billing Guidelines

Tuesday, December 15, 2020

Effective with date of service Nov. 13, 2020, the Medicaid and NC Health Choice programs cover meningococcal [Groups A, C, Y, W] conjugate vaccine, solution for intramuscular injection (MenQuadfi™) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code 90619 - Meningococcal conjugate vaccine, serogroups A, C, W, Y, quadrivalent, tetanus toxoid carrier (MenACWY-TT), for intramuscular use.

Strength/Package Size(s): Solution for injection in 0.5 mL single-dose vial.

Indicated for active immunization for the prevention of invasive meningococcal disease caused by Neisseria meningitidis serogroups A, C, W, and Y. MenQuadfi™ vaccine is approved for use in individuals two years of age and older. MenQuadfi™ does not prevent N. meningitidis serogroup B disease.

Recommended Dose: 0.5 mL dose for intramuscular injection. See full prescribing information for further detail.

For Medicaid and NC Health Choice Billing

  • The ICD-10-CM diagnosis code(s) required for billing is/are: Z23 - Encounter for immunization
  • Providers must bill with HCPCS code: 90619 - Meningococcal conjugate vaccine, serogroups A, C, W, Y, quadrivalent, tetanus toxoid carrier (MenACWY-TT), for intramuscular use
  • One Medicaid and NC Health Choice unit of coverage is: 0.5 mL 
  • The maximum reimbursement rate per unit is: $152.15
  • Providers must bill 11-digit NDCs and appropriate NDC units.  The NDCs is/are: 49281-0590-05, 49281-0590-58
  • The NDC units should be reported as “UN1”
  • For additional information, refer to the January 2012 Special Bulletin National Drug Code Implementation Update
  • For additional information regarding NDC claim requirements related to the PADP, refer to the PADP Clinical Coverage Policy 1B, Attachment A, H.7 on Medicaid's website
  • Providers shall bill their usual and customary charge for non-340B drugs
  • PADP reimburses for drugs billed for Medicaid and Health Choice beneficiaries by 340B participating providers who have registered with the Office of Pharmacy Affairs (OPA). Providers billing for 340B drugs shall bill the cost that is reflective of their acquisition cost. Providers shall indicate that a drug was purchased under a 340B purchasing agreement by appending the “UD” modifier on the drug detail.
  • The fee schedule for the PADP is available on Medicaid's PADP web page

Contact

NCTracks Contact Center: 800-688-6696