Effective with date of service Oct. 1, 2023, NC Medicaid Direct and NC Medicaid Managed Care cover cholera vaccine, live, oral suspension for oral administration (Vaxchora) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code 90625 - Cholera vaccine, live, adult dosage, one dose schedule, for oral use.
Strength/Package Size: Suspension for oral administration supplied as a packet of the buffer component and a packet of the active component (lyophilized V. cholerae CVD 103-HgR). After preparation, a single dose of Vaxchora is 100 mL for persons six years through 64 years of age or 50 mL for children two through five years of age.
Cholera vaccine, live, oral suspension for oral administration is indicated for active immunization against disease caused by Vibrio cholerae serogroup O1. Vaxchora is approved for use in persons two through 64 years of age traveling to cholera-affected areas.
Limitations of Use:
- The effectiveness of Vaxchora has not been established in persons living in cholera-affected areas.
- The effectiveness of Vaxchora has not been established in persons who have pre-existing immunity due to previous exposure to V. cholerae or receipt of a cholera vaccine.
- Vaxchora has not been shown to protect against disease caused by V. cholerae serogroup O139 or other non-O1 serogroups.
Recommended Dose: After reconstitution, a single dose of Vaxchora is 100 mL for persons six through 64 years or 50 mL for children two through five years of age.
See full prescribing information for further detail.
For Medicaid Billing
- The ICD-10-CM diagnosis code required for billing is: Z23 - Encounter for immunization
- Providers must bill with HCPCS code: 90625 - Cholera vaccine, live, adult dosage, 1 dose schedule, for oral use
- One Medicaid unit of coverage is: 1 adult dosage (100 mL)
- The maximum reimbursement rate per unit is: NDC specific SMAC rate. See fee schedule for current rate.
- Providers must bill 11-digit NDCs and appropriate NDC units. The NDC is: 70460-0004-01
- The NDC units should be reported as "UN1"
- For additional information, refer to the January 2012, Special Bulletin, National Drug Code Implementation Update.
- For additional information regarding NDC claim requirements related to the PADP, refer to the PADP Clinical Coverage Policy 1B, Attachment A, H.7 on Medicaid’s website.
- Providers shall bill their usual and customary charge for non-340B drugs.
- PADP reimburses for drugs billed for Medicaid beneficiaries by 340B participating providers who have registered with the Office of Pharmacy Affairs (OPA). Providers billing for 340B drugs shall bill the cost that is their actual acquisition cost. Providers shall indicate that a drug was purchased under a 340B purchasing agreement by appending the "UD" modifier on the drug detail.
- The fee schedule for the PADP is available on the NC Medicaid Fee Schedule & Covered Code portal.
ICD-10-CM Manual. American Medical Association, 2023 manual.
*Information current as of Sept. 26, 2023, and is not a substitute for professional judgment. For full prescribing information, please refer to current package insert or other appropriate sources prior to making clinical judgments.
Contact
NCTracks Call Center: 800-688-6696