SPECIAL BULLETIN COVID-19 #147: Moderna COVID-19 Vaccine (N/A) HCPCS code 91301: Billing Guidelines

Tuesday, December 29, 2020

The following information is only for non-long-term care providers who have the means to handle the specific storage recommendations required of the Moderna COVID-19 vaccine and will be administering it. This is the first general communication regarding the COVID-19 vaccine. NC Medicaid will issue subsequent guidance regarding specific vaccination programs and/or specific FDA approved vaccines as information becomes available. 

The CDC has released Interim Guidance for Immunization Services During the COVID-19 Pandemic. This guidance is intended to help immunization providers in a variety of clinical and alternative settings with the safe administration of vaccines during the COVID-19 pandemic.

If you have any questions about product specific information, please contact the Immunization Branch Help Desk at 1-877-873-6247 and press option ‘6.’ If you have any questions about billing NC Medicaid, please call the GDIT Call Center at 1-800-688-6696.

For Medicaid and NC Health Choice Billing

  • The ICD-10-CM diagnosis code required for billing is:  Z23 - Encounter for immunization
  • Providers must bill with HCPCS code: 91301 - Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 100 mcg/0.5mL dosage, for intramuscular use
  • One Medicaid and NC Health Choice unit of coverage is: 0.5 mL
  • The maximum reimbursement rate per unit is: N/A
  • Providers must bill 11-digit NDCs: 80777-0273-10, 80777-0273-99
  • The NDC units should be reported as "UN1"
  • The fee schedule for the PADP is available on Medicaid's PADP web page.

Important Claims Information

  • Medicaid and NC Health Choice will reimburse at the Medicare approved COVID-19 vaccination administration rate at first dose $16.94 and second dose $28.39.
  • Claims must have appropriate NDCs that correspond to the vaccine used for administration and corresponding CPT code.
  • Claims must contain both administration codes and vaccine codes to pay.
  • Vaccine codes should be reported as $0.00.
  • Claims for first vaccine dose must have been processed in NCTracks prior to processing a claim for second dose. 
  • Medicaid and NC Health Choice do not allow copays to be charged for COVID-19 immunization or administrations.
  • COVID-19 vaccines are exempt from the Vaccines for Children (VFC) program.
  • TJ modifier should be used for NC Health Choice claims (age 6 through 18 years).
  • EP modifier should be used for all non-NC Health Choice (only Medicaid beneficiaries) younger than 21 years of age.
  • CG modifier should be used for claims submitted by a pharmacy participating in the immunization program for both the vaccine and administration codes (EXCEPTION: CVS/Walgreens pharmacies participating in the Long-Term Care immunization program for beneficiaries residing at the participating LTC facilities).

COVID-19 Vaccine Billing Codes for Medicaid and NC Health Choice Beneficiaries

Administration CPT Codes to Bill

Administration CPT Code(s) to Bill

CPT Code Description

0011A

Immunization administration by intramuscular injection of Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 100 mcg/0.5mL dosage; first dose

0012A

Immunization administration by intramuscular injection of Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 100 mcg/0.5mL dosage; second dose

 

 

 

 

 

 

Vaccine CPT Code to Report

Vaccine CPT Code to Report

NDC

CPT Code Description

91301

80777-0273-10
80777-0273-99

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 100 mcg/0.5mL dosage, for intramuscular use

 

 

 

Contact

NCTracks Contact Center: 800-688-6696