SPECIAL BULLETIN COVID-19 #201: Booster Dose of COVID-19 Vaccines for All Adults
Information on Moderna, Pfizer-BioNTech and Johnson & Johnson Vaccines

The Food and Drug Administration and the Advisory Committee on Immunization Practices have authorized COVID-19 boosters for all adults (18 years and older).

On Nov. 19, 2021, the Food and Drug Administration and the Advisory Committee on Immunization Practices authorized COVID-19 boosters for all adults (18 years and older) at least six months after initial shots with the Moderna or Pfizer-BioNTech COVID-19 vaccines.

Anyone who received a single shot of the Johnson & Johnson vaccine is already eligible for a booster two months after their initial dose.

The authorization expands eligibility for boosters, which had been limited to adults 65 and older and to those with higher risk of severe infection or whose jobs put them at increased risk, to anyone 18 and older.

Beginning Nov. 19, 2021, NC Medicaid vaccine providers may begin administering the booster dose of COVID-19 vaccines to all age-appropriate beneficiaries. Payment amount will be equivalent as for administration of other doses of the COVID-19 vaccine at $40 each.

Vaccine CPT Code

Administration Code

CPT Code Description

91300 (Pfizer; dilution required)

0004A

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, 30 mcg/0.3 mL dosage, diluent reconstituted: booster dose

91303 (Johnson & Johnson/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

91305 (Pfizer; does not require dilution)

0054A

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, 30 mcg/0.3 mL dosage, tris-sucrose formulation; booster dose

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

For Medicaid and NC Health Choice Billing

  • 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:
    • Pfizer (requires dilution) - CPT code 91300 – NDC 00069-1000-02, 00069-1000-03
    • Janssen - CPT code 91303 – NDC 59676-0580-05, 59676-0580-15
    • Pfizer (does not require dilution) - CPT code 91305 – NDC 59267-1025-01, 59267-1025-02, 59267-1025-03, 59267-1025-04
    • Moderna - CPT code 91306 – NDC 80777-0273-98, 80777-0273-99, 80777-0273-10, 80777-0273-15
  • 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 six 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.
  • SK modifier may be used for any immunizing provider who does not currently have prescriptive authority (standing order issued by State Health Director may be used).
  • Pharmacies with an immunizing pharmacist may administer any COVID-19 vaccine to any Medicaid and NC Health Choice beneficiary as age appropriate.
    • All other vaccines (non-COVID-19 vaccines), that are approved by the NC Board of Pharmacy to be administered by an immunizing pharmacist, are permissible to be administered for Medicaid beneficiaries ONLY (not for Health Choice) 19 years and older

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

Contact

NCTracks Contact Center: 800-688-6696

 

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