May 17, 2022. This bulletin was updated to correct a typo on the Moderna booster code number.
April 29, 2022. This bulletin was updated to include information on “Red Top” option for “Blue Top” Vials.
UPDATED INFORMATION:
As of April 26, 2022, providers can use the Moderna Booster vaccine “Red Top” vial (Code 91306 and 0064A) if the “Blue Top” (Code 91309 and 0094A) vials are difficult to obtain.
- Code 91306 - Severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 50 mcg/0.25 mL dosage, for intramuscular use
- Code 0064A - Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 50 mcg/0.25 mL dosage, booster dose
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On March 29, 2022, the Food and Drug Administration approved a second booster dose of the Pfizer-BioNTech COVID-19 and Moderna COVID-19 vaccines to be administered to individuals who:
- Are age 50 or older and received the first booster shot at least FOUR months ago.
- Are age 12 or older and have a compromised immune system and received the first booster shot at least FOUR months ago
- Received a total of two shots of the Johnson & Johnson vaccine at least FOUR months ago.
Effective March 29, 2022, NC Medicaid will reimburse providers for the administration of a second booster dose of the Pfizer-BioNTech or the Moderna COVID-19 vaccine to any qualifying beneficiary.
Pfizer-BioNTech second booster vaccine should be billed as is currently accepted practice for booster doses and until further notice of code changes per the American Medical Association or Center for Medicare and Medicaid Services (CMS).
- Code 91300 - Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3mL dosage, diluent reconstituted, for intramuscular use
- Code 0004A - Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (coronavirus disease [COVID-19]) vaccine, mRNALNP, spike protein, preservative free, 30 mcg/0.3 mL dosage, diluent reconstituted; booster dose
OR
- Code 91305 - 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, for intramuscular use.
- Code 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
Moderna second booster vaccine should be billed with CPT code 91309 and administration code 0094A as recommended by CMS. PLEASE NOTE UPDATE to this Moderna information above.
- Code 91309 - Severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 50 mcg/0.5 mL dosage, for intramuscular use
- Code 0094A - Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 50 mcg/0.5 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.
- Providers must bill with HCPCS code.
- Claims must have appropriate NDCs, which 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.
- 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.
Other Resources and Links
NC Medicaid SPECIAL BULLETINS COVID-19
NC Medical Health Director’s updated standing order for Pfizer-BioNtech
NC Medical Health Director’s updated standing order for Moderna
Contact
NCTracks Contact Center: 800-688-6696