SPECIAL BULLETIN COVID-19 #195: Booster Dose of Pfizer, Moderna and Janssen Vaccines
Update on booster shot doses, codes and payment

Update on COVID-19 booster shot recommendations for Pfizer, Moderna and Janssen

On Oct 20, 2021, the Federal Drug Administration (FDA) recommended for individuals who received a Pfizer-BioNTech or Moderna COVID-19 vaccine, the following groups are eligible for a booster shot at six months or more after their initial series:

For those who got the Janssen (Johnson & Johnson) COVID-19 vaccine, booster shots are also recommended for those who are 18 and older and who were vaccinated two or more months ago.

More information on the FDA’s authorization is available for the Moderna vaccine and the Janssen vaccine.

Eligible individuals may choose which vaccine they receive as a booster dose. Some people may have a preference for the vaccine type that they originally received and others may prefer to get a different booster. The Centers for Disease Control’s (CDC’s) recommendations now allow for this type of mix and match dosing for booster shots. NC Medicaid beneficiaries should talk to their health care provider about whether getting a COVID-19 booster shot is appropriate for them.

Beginning Oct 20, 2021, NC Medicaid vaccine providers may begin administering the booster dose of COVID-19 vaccine to those beneficiaries who qualify and by self-attestation. Payment amount will be equivalent to other doses of the COVID-19 vaccine at $40 each.

For Medicaid and NC Health Choice Billing

Vaccine CPT Code

Administration CPT Code

CPT Code Description

91306

(Moderna)

0064A

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, 50 mcg/0.25 mL dosage, booster dose

91303

(Janssen)

0034A

Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, DNA, spike protein, adenovirus type 26 (Ad26) vector, preservative free, 5x1010 viral particles/0.5 mL dosage; booster dose
  • The ICD-10-CM diagnosis code required for billing is: Z23 - Encounter for immunization
  • The maximum reimbursement rate per unit is: N/A (only administration charge will be reimbursed)
  • Claims must have appropriate NDCs, which correspond to the vaccine used for administration and corresponding CPT code:
  • Moderna CPT code 91306 – NDC 80777027310
  • Janssen CPT code 91303 – NDC 59676058005
  • Claims must contain both administration codes and vaccine codes to pay
  • Vaccine codes should be reported as $0.00
  • 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.

Please see the updated Interim Clinical Considerations for use of COVID-19 Vaccines Currently Authorized in the United States for more details.

CONTACT

NCTracks Call Center: 800-688-6696

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