Seven Topics Related to COVID-19 Vaccines and Vaccine Counseling
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:
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Pfizer-BioNTech COVID-19 Vaccines for children age 6 months to 4 years
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Moderna COVID-19 Vaccines for children age 6 months to 5 years
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Moderna COVID-19 Vaccines for children age 6 to 17 years
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Claims previously held for Code 0074A may now be submitted
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COVID-19 Vaccine Counseling for EPSDT Eligible Individuals
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Stand Alone Vaccine Counseling
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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 |
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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 |
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Moderna |
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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 |
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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 |
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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 |
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*Government supplied vaccine Note: The COVID-19 vaccine administration codes have been added for roster billing |
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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 |
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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 |
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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 |
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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 |
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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 |
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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 |
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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 |
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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 |
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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 |
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*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 |
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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 |
|
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EPDST COVID-19 Immunization Counseling |
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99429 |
unlisted preventive medicine service |
April 1, 2021-June 7, 2022 |
$35.46 |
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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 |
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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 |
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* New codes effective June 8, 2022 |
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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 |
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Immunization Counseling |
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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 |
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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 |
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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 |
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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 |
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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 |
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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 |
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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 |
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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 |
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Code |
Description |
Effective Date |
MaineCare Rate |
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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 |
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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 |
07/13/22 |
$36.98 |
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*Government supplied vaccine Note: The COVID-19 vaccine administration codes have been added for roster billing |
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If you have questions about Novavax COVID-19 vaccine billing, please contact your Provider Relations Specialist.