Pfizer and Moderna Bivalent COVID-19 Vaccines Authorized to use as Booster Doses-Update
On September 2, 2022, the Office of MaineCare Services (OMS) sent an announcement that we will cover the Pfizer and Moderna bivalent COVID-19 vaccine booster doses as outlined in an Emergency Use Authorization (EUA) from the Food and Drug Administration (FDA).
OMS has completed the update to our systems, and you may begin to submit claims for these services.
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Moderna COVID-19 Vaccine Bivalent Booster-18 years and older |
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Code |
Description |
Effective Date |
MaineCare Rate |
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91313 |
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, bivalent, preservative free, 50 mcg/0.5 mL dosage, for intramuscular use |
08/31/22 |
$0* |
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0134A |
Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, bivalent, preservative free, 50 mcg/0.5 mL dosage, booster dose |
08/31/22 |
$36.98 |
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Pfizer BioN-Tech COVID-19 Vaccine Bivalent Booster-12 years and older |
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Code |
Description |
Effective Date |
MaineCare Rate |
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91312 |
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, bivalent spike protein, preservative free, 30 mcg/0.3 mL dosage, tris-sucrose formulation, for intramuscular use |
08/31/22 |
$0* |
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0124A |
Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, bivalent spike protein, preservative free, 30 mcg/0.3 mL dosage, tris-sucrose formulation, booster dose |
08/31/22 |
$36.98 |
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*Government Supplied Vaccines
Note: The COVID-19 vaccine administration codes will be added for roster billing |
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Please be reminded that this authorization replaces the prior EUAs for the Monovalent COVID-19 vaccine booster dose from these suppliers for individuals ages 12 and older.
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No Longer Authorized-Pfizer BioN-Tech COVID-19 Vaccine Booster-12 years and older |
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Code |
Description |
Effective Date |
End Date |
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91300 |
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3mL dosage, diluent reconstituted, for intramuscular use |
12/11/2020 |
08/31/22* |
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0004A |
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, 30 mcg/0.3 mL dosage, diluent reconstituted; booster dose |
9/22/2021 |
08/31/22 |
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91305 |
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3 mL dosage, trissucrose formulation, for intramuscular use |
1/3/2022 |
08/31/22* |
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0054A |
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, 30 mcg/0.3 mL dosage, tris-sucrose formulation; booster dose |
1/3/2022 |
08/31/22 |
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No Longer Authorized-Moderna COVID-19 Vaccine Booster-18 years and older |
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91306 |
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 50 mcg/0.25 mL dosage, for intramuscular use |
10/21/2021 |
08/31/22* |
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0064A |
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, 50 mcg/0.25 mL dosage, booster dose |
10/20/2021 |
08/31/22 |
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0094A |
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, 50 mcg/0.5 mL dosage, booster dose |
3/29/2022 |
08/31/22 |
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*Drug is only authorized for use with a Primary Dose Covid Vaccine Series. Do not use this drug code when billing booster doses for the age ranges specified. |
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Providers may visit the Maine CDC Immunization Program Website for up-to-date information on administering and ordering COVID-19 vaccine and booster doses.
If you have questions about the use of Monovalent or Bivalent COVID-19 vaccine booster doses, please contact your Provider Relations Specialist.
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