2023 Rates for COVID-19 Codes, CR 114822 

Effective January 1, 2023, we updated the COVID-19 rates listed below. We adjusted affected claims on March 13, 2023.    

Code  

Description  

Rate  

0001A        

imm admn sarscov2 30mcg/0.3ml dil recon 1st dose              

$39.11  

0002A        

imm admn sarscov2 30mcg/0.3ml dil recon 2nd dose              

$39.11  

0003A        

imm admn sarscov2 30mcg/0.3ml dil recon 3rd dose              

$39.11  

0011A        

imm admn sarscov2 100 mcg/0.5 ml 1st dose                     

$39.11  

0012A        

imm admn sarscov2 100 mcg/0.5 ml 2nd dose                     

$39.11  

0013A        

imm admn sarscov2 100 mcg/0.5 ml 3rd dose                     

$39.11  

0031A        

imm admn sarscov2 ad26 5x1010vp/0.5 ml 1 dose                 

$39.11  

0034A        

imm admn sarscov2 ad26 5x1010 vp/0.5 ml bst dose              

$39.11  

0041A        

imm admn sarscov2 5 mcg/0.5 ml 1st dose                       

$39.11  

0042A        

imm admn sarscov2 5 mcg/0.5 ml 2nd dose                       

$39.11  

0044A        

imm admn sarscov2 5 mcg/0.5 ml bst                            

$39.11  

0051A        

imm admn sarscov2 30mcg/0.3ml tris-sucrose 1st                

$39.11  

0052A        

imm admn sarscov2 30mcg/0.3ml tris-sucrose 2nd                

$39.11  

0053A        

imm admn sarscov2 30mcg/0.3ml tris-sucrose 3rd                

$39.11  

0071A        

imm admn sarscov2 10mcg/0.2ml tris-sucrose 1st                

$39.11  

0072A        

imm admn sarscov2 10mcg/0.2ml tris-sucrose 2nd                

$39.11  

0073A        

imm admn sarscov2 10mcg/0.2ml tris-sucrose 3rd                

$39.11  

0081A        

imm admn sarscov2 3mcg/0.2ml tris-sucrose 1st                 

$39.11  

0082A        

imm admn sarscov2 3mcg/0.2ml tris-sucrose 2nd                 

$39.11  

0083A        

imm admn sarscov2 3mcg/0.2ml tris-sucrose 3rd                 

$39.11  

0091A        

imm admn sarscov2 50 mcg/0.5 ml 1st dose 6-11                 

$39.11  

0092A        

imm admn sarscov2 50 mcg/0.5 ml 2nd dose 6-11                 

$39.11  

0093A        

imm admn sarscov2 50 mcg/0.5 ml 3rd dose 6-11                 

$39.11  

0111A        

imm admn sarscov2 25 mcg/0.25 ml 1st dose                     

$39.11  

0112A        

imm admn sarscov2 25 mcg/0.25 ml 2nd dose                     

$39.11  

0113A        

imm admn sarscov2 25 mcg/0.25 ml 3rd dose                     

$39.11  

0124A        

imm admn sarscov2 bivalent 30 mcg/0.3 ml bst                  

$39.11  

0134A        

imm admn sarscov2 bivalent 50 mcg/0.5 ml bst                  

$39.11  

0144A        

imm admn sarscov2 bivalent 25 mcg/1.25 ml bst                 

$39.11  

0154A        

imm admin sarscov2 bivalet 10 mcg/0.2 ml bst                  

$39.11  

0164A  

imm admn sarscov2 bivalent 10 mcg/0.2 ml bst  

$39.11  

0173A  

imm admn sarscov2 bivalent 3 mcg/0.2 ml 3rd  

$39.11  

M0201        

COVID-19 vaccine home admin                                   

$34.71  

M0220        

Tixagevimab and cilgavimab inj and post adm mon – Ending 01/25/2023             

$102.64  

M0221        

Tixagevimab and cilgavimab inj home – Ending 1/25/2023                           

$170.84  

M0249        

Admin Tocilizu COVID-19 1st                                   

$306.90  

M0250        

AdmIN Tocilizu COVID-19 2nd                                   

$306.90  

  Please contact your Provider Relations Specialist with questions.  

Check out our new MaineCare logo! Learn more about this logo on the About Us page of our website.

MaineCare logo