SPECIAL BULLETIN COVID-19 #249: Pfizer-BioNTech Vaccine Booster Dose for Children Age 5 through 11 Coverage for single booster dose

Effective May 19, 2022, Medicaid and NC Health Choice will cover the use of a single booster dose for administration to children age 5 through 11 at least five months after completion of a primary series with the Pfizer Pediatric COVID-19 Vaccine. 

Pfizer Pediatric COVID-19 Vaccine is a preservative-free suspension for injection in a multiple dose vial. It is administered intramuscularly as a single dose (0.2 mL). See full prescribing information for further detail.

Administration code for Pfizer Pediatric Booster dose

• 91307 - Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 10 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation, for intramuscular use
• 0074A - 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, 10 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation; booster dose

See SPECIAL BULLETIN COVID-19 #196 for billing details about Pfizer-BioNTech Pediatric Vaccine.

CONTACT

NCTracks Contact Center: 800-688-6696