COVID-19 Vaccines for Fall 2023 Claim Submission Update
On October 23, 2023, the Office of MaineCare Services (OMS) sent a bulletin regarding the coverage of COVID-19 vaccines.
OMS has completed the update to our systems, and you may begin to submit claims for these services.
These rates are applicable only to vaccines that have been directly purchased. Any vaccine that is received via government supply or through the Vaccines for Children’s program will require the use of the SL modifier and will be reimbursed at $0.
|
COVID- 19 Billing Codes |
|||
|
Pfizer BioN-Tech COVID-19 Vaccine – 6 months through 4 years old |
|||
|
Code |
Description |
Effective Date |
MaineCare Rate |
|
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 |
$65.36 |
|
Pfizer BioN-Tech COVID-19 Vaccine – 5 years through 11 years old |
|||
|
Code |
Description |
Effective Date |
MaineCare Rate |
|
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 |
$87.78 |
|
Pfizer BioN-Tech COVID-19 Vaccine – 12 years and older |
|||
|
Code |
Description |
Effective Date |
MaineCare Rate |
|
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 |
$131.10 |
|
Moderna COVID-19 Vaccine – 6 months through 11 years old |
|||
|
Code |
Description |
Effective Date |
MaineCare Rate |
|
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 |
$145.92 |
|
Moderna COVID-19 Vaccine – 12 years and older |
|||
|
Code |
Description |
Effective Date |
MaineCare Rate |
|
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 |
145.92 |
|
Novavax COVID-19 Vaccine – 12 years and older |
|||
|
Code |
Description |
Effective Date |
MaineCare Rate |
|
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 |
10/03/2023 |
$148.20 |
|
COVID-19 Vaccine Administration |
|||
|
Code |
Description |
Effective Date |
MaineCare Rate |
|
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 |
|
Note: The COVID-19 vaccine administration code will be added for roster billing |
|||
Please be reminded, 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.
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.
Check out our new MaineCare logo! Learn more about this logo on the About Us page of our website.
