This Bulletin updates rates previously published in SPECIAL BULLETIN COVID-19 #152 and SPECIAL BULLETIN COVID-19 #160.
Effective March 15, 2021, NC Medicaid is aligning reimbursement for COVID-19 vaccine administration with the Centers for Medicare & Medicaid Services' (CMS) increased Medicare rate of $40 per dose. This higher payment rate will support important actions taken by providers that are designed to increase the number of vaccines they can furnish each day. At a time when vaccine supply is growing, NC Medicaid is supporting provider efforts to expand capacity and ensure that all NC Medicaid beneficiaries are vaccinated against COVID-19 as soon as possible.
NC Medicaid is increasing the reimbursement rate for administration of each dose of the following COVID-19 vaccines:
- PFIZER-BioNTech COVID-19 Vaccine
- Moderna COVID-19 Vaccine
- Janssen COVID-19 Vaccine
Starting March 15, 2021, Medicaid will pay $40 for the administration of single-dose COVID-19 vaccines. For COVID-19 vaccines requiring multiple doses, Medicaid will pay $40 for each dose in the series.
Medicaid and NC Health Choice claims submitted with dates of service prior to March 15, 2021, will continue to be reimbursed at the Medicare-approved COVID-19 vaccination administration first dose rate of $16.94 and the second dose rate of $28.39.
Please refer to previously released Special Bulletins #152 and #160 for COVID-19 vaccine billing guidance.
Contact
NCTracks Contact Center: 800-688-6696