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Seven Topics Related to COVID-19 Vaccines and Vaccine Counseling

Aug 17, 2022

The following message contains information on 7 topics related to COVID-19 vaccines and vaccine counseling. They have been combined into one message to limit the number of messages arriving in provider inboxes. Not all information pertains to all providers. The following messages are included:

Pfizer-BioNTech COVID-19 Vaccines for children age 6 months to 4 years
Moderna COVID-19 Vaccines for children age 6 months to 5 years
Moderna COVID-19 Vaccines for children age 6 to 17 years

Claims previously held for Code 0074A may now be submitted
COVID-19 Vaccine Counseling for EPSDT Eligible Individuals
Stand Alone Vaccine Counseling
Novavax COVID-19 vaccine for individuals age 18 and older

Please review the messages for information that pertains to your agency. Additionally, please be sure to review effective dates and member eligibility, as it varies in each section. Thank you.

Moderna and Pfizer-BioNTech Vaccines for the Prevention of COVID-19 for Children 6 Months and Older

Effective June 17, 2022, the Food and Drug Administration (FDA) authorized emergency use of the Moderna and Pfizer-BioNTech vaccines for the prevention of COVID-19 to include children as young as 6 months. MaineCare has updated the claims system to include the following codes for these services.   

Code	Description	MaineCare Effective Date	Rates
Pfizer
91308*	Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 3 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation, for intramuscular use	June 17, 2022	$0
0081A	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, 3 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation; first dose	June 17, 2022	$36.98
0082A	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, 3 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation; second dose	June 17, 2022	$36.98
0083A	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, 3 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation; third dose	June 17, 2022	$36.98
Moderna
91311*	Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 25 mcg/0.25 mL dosage, for intramuscular use	June 17, 2022	$0
0111A	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, 25 mcg/0.25 mL dosage; first dose	June 17, 2022	$36.98
0112A	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, 25 mcg/0.25 mL dosage; second dose	June 17, 2022	$36.98
0113A	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, 25 mcg/0.25 mL dosage; third dose	June 17, 2022	$36.98
*Government supplied vaccine  Note: The COVID-19 vaccine administration codes have been added for roster billing

 For questions, please contact your Provider Relations Specialist.

Moderna COVID-19 Vaccine for the Prevention of COVID-19 for Children 6 Years through 17 Years of Age

The June 17, 2022, Food and Drug Administration (FDA) authorization for emergency use of the Moderna vaccine also updated the age range eligibility for the Moderna COVID-19 vaccine to include those children aged 6 years through 17 years. The following codes may be billed to cover those services.    

Code	Description	MaineCare Effective Date	Rates
Moderna Pediatric Vaccine Age 6 through 17 years
91309*	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, for intramuscular use	March 29, 2022	$0
0091A	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; first dose, when administered to individuals 6 through 11 year	June 17, 2022	$36.98
0092A	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; second dose, when administered to individuals 6 through 11 year	June 17, 2022	$36.98
0093A	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; third dose, when administered to individuals 6 through 11 year	June 17, 2022	$36.98
91301*	Severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 100 mcg/0.5mL dosage, for intramuscular use	March 11, 2021	$0
0011A**	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, 100 mcg/0.5mL dosage; first dose	March 11, 2021	$36.98
0012A**	Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (coronavirus disease [COVID-19]) vaccine, DNA, spike protein, chimpanzee adenovirus Oxford 1 (ChAdOx1) vector, preservative free, 5x1010 viral particles/0.5mL dosage; second dose	March 11, 2021	$36.98
0013A**	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, 100 mcg/0.5 mL dosage; third dose	March 11, 2021	$36.98
Government supplied vaccine  *Code use was expanded to include ages 12-17  Note: The COVID-19 vaccine administration codes have been added for roster billing

For questions, please contact your Provider Relations Specialist. 

COVID-19 Vaccine Administration Code 0074A is now Updated in Our System 

On June 3, 2022, the Office of MaineCare Services (OMS) issued notice to providers to hold claims for the administration of the Pfizer pediatric COVID-19 vaccine booster which received Emergency Use Authorization (EUA) by the Food and Drug Administration (FDA) on May 17, 2022. Effective June 15, 2022, the OMS claims processing system is now updated and providers may submit held claims or resubmit denied claims for code 0074A. 

For questions, please contact your Provider Relations Specialist. 

COVID-19 Vaccine Counseling for Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Eligible Individuals 

Under the American Rescue Plan Act (ARP), the Centers for Medicare & Medicaid Services (CMS) requires states to cover COVID-19 vaccine counseling visits for families and children under Early and Periodic Screening, Diagnostic and Treatment (EPSDT). MaineCare will cover COVID-19 vaccine counseling services for individuals under 21 years of age under MaineCare Benefits Manual Sections 3, 14, 40, 45, and 90, retroactive to April 1, 2021. 

Code	Description	MaineCare Effective Date	Rates
	EPDST COVID-19 Immunization Counseling
99429	unlisted preventive medicine service	April 1, 2021-June 7, 2022	$35.46
G0314*	Immunization counseling by a physician or other qualified health care professional for COVID-19, ages under 21, 16-30 mins time. (This code is used for the Medicaid Early and Periodic Screening, Diagnostic, and Treatment Benefit (EPSDT).	June 8, 2022	$35.46
G0315*	Immunization counseling by a physician or other qualified health care professional for COVID-19, ages under 21, 5-15 mins time. (This code is used for the Medicaid Early and Periodic Screening, Diagnostic, and Treatment Benefit (EPSDT).	June 8, 2022	$35.46
* New codes effective June 8, 2022

For questions, please contact your Provider Relations Specialist.

Stand-Alone Vaccine Counseling 

The Office of MaineCare Services (OMS) will also cover stand-alone immunization counseling effective June 8, 2022. Eligible members of any age can receive stand-alone counseling for the codes listed below. Stand-alone counseling codes may not be billed during the same visit in which the vaccine is administered.  

Code	Description	MaineCare Effective Date	Rates
	Immunization Counseling
G0310	Immunization counseling by a physician or other qualified health care professional when the vaccine(s) is not administered on the same date of service, 5 to 15 mins time. (This code is used for Medicaid billing purposes.)	June 8, 2022- June 30, 2002	$6.15
G0310	Immunization counseling by a physician or other qualified health care professional when the vaccine(s) is not administered on the same date of service, 5 to 15 mins time. (This code is used for Medicaid billing purposes.)	July 1, 2022	$26.63
G0311	Immunization counseling by a physician or other qualified health care professional when the vaccine(s) is not administered on the same date of service, 16-30 mins time. (This code is used for Medicaid billing purposes.)	June 8, 2022- June 30, 2022	$6.15
G0311	Immunization counseling by a physician or other qualified health care professional when the vaccine(s) is not administered on the same date of service, 16-30 mins time. (This code is used for Medicaid billing purposes.)	July 1, 2022	$26.63
G0312	Immunization counseling by a physician or other qualified health care professional when the vaccine(s) is not administered on the same date of service for ages under 21, 5 to 15 mins time. (This code is used for Medicaid billing purposes.)	June 8, 2022- June 30, 2022	$6.15
G0312	Immunization counseling by a physician or other qualified health care professional when the vaccine(s) is not administered on the same date of service for ages under 21, 5 to 15 mins time. (This code is used for Medicaid billing purposes.)	July 1, 2022	$26.63
G0313	Immunization counseling by a physician or other qualified health care professional when the vaccine(s) is not administered on the same date of service for ages under 21, 16-30 mins time. (This code is used for Medicaid billing purposes.)	June 8, 2022- June 30, 2022	$6.15
G0313	Immunization counseling by a physician or other qualified health care professional when the vaccine(s) is not administered on the same date of service for ages under 21, 16-30 mins time. (This code is used for Medicaid billing purposes.)	July 1, 2022	$26.63

For the latest information on covid-related codes, please check here. 

Please contact your Provider Relations Specialist with questions.  

Novavax COVID-19 Vaccine Codes Added  

Effective July 13, 2022, the Food and Drug Administration (FDA) issued an Emergency Use Authorization (EUA) for the use of the Novavax COVID-19 vaccine for individuals 18 and older. The Office of MaineCare Services (OMS) completed a system update to add the Novavax COVID-19 vaccine codes. Please review the following table for more information.    

COVID-19 Novavax COVID-19 Vaccine Codes
Code	Description	Effective Date	MaineCare Rate
91304	Severe acute respiratory syndrome coronavirus 2 (SARSCoV- 2) (coronavirus disease [COVID-19]) vaccine, recombinant spike protein nanoparticle, saponin-based	07/13/22	$0*
0041A	Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (coronavirus disease [COVID-19]) vaccine, recombinant spike protein nanoparticle, saponin-based adjuvant, preservative free, 5 mcg/0.5 mL dosage; first dose	07/13/22	$36.98
0042A	Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (coronavirus disease [COVID-19]) vaccine, recombinant spike protein nanoparticle, saponin-based adjuvant, preservative free, 5 mcg/0.5 mL dosage; second dose	07/13/22	$36.98
*Government supplied vaccine  Note: The COVID-19 vaccine administration codes have been added for roster billing

 If you have questions about Novavax COVID-19 vaccine billing, please contact your Provider Relations Specialist.   