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