July 14, 2022. This bulletin was updated in SPECIAL BULLETIN COVID-19 #261 to reflect new Moderna Pediatric Vaccine codes.
Effective June 24, 2022, NC Medicaid and NC Health Choice will cover the administration of the primary series of the Moderna COVID-19 pediatric vaccine for administration to children ages 6 through 11.
At present, the Moderna “Booster Only” formulation can be used to administer primary series doses to children ages 6 to 11. This product is only authorized for use as the primary series in this age group, and NOT for boosters at this time. Pfizer continues to be the product authorized for booster doses in the 6 to 11 age group. In the future, the Moderna COVID-19 Vaccine for those ages 6 through 11 will be packaged with a teal cap and distributed as a separate product.
Please use the following codes for billing:
- 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
Note: Please use 0094A code multiple times to bill for the series of vaccinations until new codes are available. Please note that these codes are also used for billing the Moderna COVID-19 Booster Vaccine as recommended by CMS for those ages 18 and older.
A provider communication from NCDHHS is available.
The Statewide Standing Order (SWSO) FDA EUA Moderna for ages 6 through 11 and Moderna ages 12 and older are now published online and available:
- Statewide Standing Order for Moderna mRNA COVID-19 Vaccine Administration in Patients 6 Through 11 Years (June 23, 2022)
- Statewide Standing Order for FDA Authorized Moderna COVID-19 Vaccine Administration in Patients 12 Years and Older (June 23, 2022)
All current SWSOs are available on the NCDHHS webpages for pharmacists and providers.
Please review the Fact Sheets for health care providers:
- Moderna: Moderna Recipients Ages 6 through 11
- Moderna: Moderna Recipients Ages 12 and older
- Moderna: Product Guide
CONTACT
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