COVID-19 Vaccine Updates for Fall 2023
MaineCare will continue to provide full coverage, without cost sharing through September 30, 2024, for the COVID-19 vaccine and its administration as required by the American Rescue Plan Act (ARPA) of 2021. The ARPA requirement applies only to those persons with current MaineCare coverage. Anyone who is uninsured or who does not have full MaineCare coverage may have access to the vaccine through the Center for Disease Controls (CDC) Bridge Access Program.
On September 11, 2023, the Food and Drug Administration (FDA) approved and authorized for emergency use updated COVID-19 vaccine formulas. As a result of this action, ALL previously authorized COVID-19 vaccines and vaccine boosters are no longer authorized. This includes both the monovalent, bivalent, and booster doses from Pfizer BioN-Tech and Moderna. The COVID-19 vaccine produced by Novavax will still be authorized for use and reimbursement.
On August 14, 2023, the American Medical Association (AMA) released a special edition of the CPT Assistant which provides new codes for the Food and Drug Administration’s (FDA) recommended COVID-19 vaccines for Fall of 2023. The streamlined billing structure now has just six (6) codes for the COVID-19 vaccine doses and one (1) code for the COVID-19 vaccine administration. Please note, the vaccine administration codes specific to the Novavax vaccine are no longer available for use, the one (1) new administration code will be used for vaccine administration for all manufacturers.
The Office of MaineCare (OMS) will be updating our systems to reflect the changes listed in the table below. OMS is asking that providers please hold COVID-19 vaccine claims until the system update is complete. Please watch for a future notice announcing the system update.
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New COVID- 19 Billing Codes |
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Pfizer BioN-Tech COVID-19 Vaccine – 6 months through 4 years old |
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Code |
Description |
Effective Date |
MaineCare Rate |
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91318 |
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, 3 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation, for intramuscular use |
09/11/2023 |
TBD |
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Pfizer BioN-Tech COVID-19 Vaccine – 5 years through 11 years old |
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Code |
Description |
Effective Date |
MaineCare Rate |
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91319 |
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, 10 mcg/0.2 mL dosage, tris-sucrose formulation, for intramuscular use |
09/11/2023 |
TBD |
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Pfizer BioN-Tech COVID-19 Vaccine – 12 years and older |
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Code |
Description |
Effective Date |
MaineCare Rate |
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91320 |
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, 30 mcg/0.3 mL dosage, tris-sucrose formulation, for intramuscular use |
09/11/2023 |
TBD |
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Moderna COVID-19 Vaccine – 6 months through 11 years old |
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Code |
Description |
Effective Date |
MaineCare Rate |
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91321 |
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, 25 mcg/0.25 mL dosage, for intramuscular use |
09/11/2023 |
TBD |
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Moderna COVID-19 Vaccine – 12 years and older |
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Code |
Description |
Effective Date |
MaineCare Rate |
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91322 |
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, 50 mcg/0.5 mL dosage, for intramuscular use |
09/11/2023 |
TBD |
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Novavax COVID-19 Vaccine – 12 years and older |
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Code |
Description |
Effective Date |
MaineCare Rate |
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91304 |
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, recombinant spike protein nanoparticle, saponin-based adjuvant, 5 mcg/0.5 mL dosage, for intramuscular use |
08/14/2023 |
TBD |
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COVID-19 Vaccine Administration |
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Code |
Description |
Effective Date |
MaineCare Rate |
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90480 |
Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, single dose |
09/11/23 |
$39.11 |
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Note: The COVID-19 vaccine administration code will be added for roster billing |
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Discontinued COVID-19 Vaccine Codes |
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Code |
Description |
Effective Date |
End Date |
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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 |
7/13/2022 |
09/12/2023 |
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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 |
7/13/2022 |
09/12/2023 |
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0044A |
Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, recombinant spike protein nanoparticle, saponinbased adjuvant, preservative free, 5 mcg/0.5 mL dosage; booster dose |
10/19/2022 |
09/12/2023 |
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91312 |
Severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (coronavirus disease [COVID-19]) vaccine, mRNALNP, bivalent spike protein, preservative free, 30 mcg/0.3 mL dosage, tris-sucrose formulation, for intramuscular use |
8/31/2022 |
09/12/2023 |
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0121A |
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; 1st Dose |
4/18/2023 |
09/12/2023 |
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0124A |
Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (coronavirus disease [COVID-19]) vaccine, mRNALNP, bivalent spike protein, preservative free, 30 mcg/0.3 mL dosage, tris-sucrose formulation, additional dose |
8/31/2022 |
09/12/2023 |
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91313 |
Severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (coronavirus disease [COVID-19]) vaccine, mRNALNP, spike protein, bivalent, preservative free, 50 mcg/0.5 mL dosage, for intramuscular use |
8/31/2022 |
09/12/2023 |
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0134A |
Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (coronavirus disease [COVID-19]) vaccine, mRNALNP, spike protein, bivalent, preservative free, 50 mcg/0.5 mL dosage, additional dose |
8/31/2022 |
09/12/2023 |
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91314 |
Severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (coronavirus disease [COVID-19]) vaccine, mRNALNP, spike protein, bivalent, preservative free, 25 mcg/0.25 mL dosage, for intramuscular use |
10/12/2022 |
09/12/2023 |
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0141A |
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease COVID-19) vaccine, mRNA-LNP, spike protein, bivalent, preservative free, 25 mcg/0.25 mL dosage, for intramuscular use; 1st dose |
4/18/2023 |
09/12/2023 |
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0142A |
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease COVID-19) vaccine, mRNA-LNP, spike protein, bivalent, preservative free, 25 mcg/0.25 mL dosage, for intramuscular use; 2nd dose |
4/18/2023 |
09/12/2023 |
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0144A |
Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNLNP, spike protein, bivalent, preservative free, 25 mcg/0.25 mL dosage, additional dose |
10/12/2022 |
09/12/2023 |
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91315 |
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, bivalent spike protein, preservative free, 10 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation, for intramuscular use |
10/12/2022 |
09/12/2023 |
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0151A |
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, bivalent spike protein, preservative free, 10 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation, for intramuscular use; 1st dose |
4/18/2023 |
09/12/2023 |
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0154A |
Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (coronavirus disease [COVID-19]) vaccine, mRNALNP, bivalent spike protein, preservative free, 10 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation, additional dose |
10/12/2022 |
09/12/2023 |
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91316 |
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, bivalent, preservative free, 10 mcg/0.2 mL dosage, for intramuscular use |
12/8/2022 |
09/12/2023 |
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0164A |
Immunization administration by intramuscular injection of severe acute |
12/8/2022 |
09/12/2023 |
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91317 |
Severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (coronavirus disease [COVID-19]) vaccine, mRNALNP, bivalent spike protein, preservative free, 3 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation, for intramuscular use |
12/8/2022 |
09/12/2023 |
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0171A |
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, bivalent spike protein, preservative free, 3 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation, for intramuscular use; 1st dose |
4/18/2023 |
09/12/2023 |
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0172A |
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, bivalent spike protein, preservative free, 3 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation, for intramuscular use; 2nd dose |
4/18/2023 |
09/12/2023 |
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0173A |
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, 3 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation, third dose |
12/8/2022 |
09/12/2023 |
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0174A |
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, 3 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation, additional dose |
3/14/2023 |
09/12/2023 |
Providers may visit the Maine CDC Immunization Program Website for up-to-date information on administering and ordering COVID-19 vaccines and booster doses.
If you have questions about COVID-19 vaccines or their administration, please contact your Provider Relations Specialist.
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