DHHS → Office of MaineCare Services (OMS) → Provider Resources → MaineCare Adds Coverage for Pfizer COVID-19 Ready-To-Use Vaccine Codes and Pediatric Third Dose Code, CR 107547 & CR 107724

MaineCare Adds Coverage for Pfizer COVID-19 Ready-To-Use Vaccine Codes and Pediatric Third Dose Code, CR 107547 & CR 107724

Feb 18, 2022

Effective January 3, 2022, the Office of MaineCare Services (OMS) has completed a system update to add the Pfizer COVID-19 ready-to-use vaccine codes. Please review the following table for more information.

COVID-19 Pfizer Ready-To-Use COVID-19 Vaccine Codes
Code	Description	Effective Date	MaineCare Rate
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	01/03/2022	$0 with the SL Modifier
0051A*	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; first dose	01/03/2022	$36.98
0052A*	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; second dose	01/03/2022	$36.98
0053A*	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; third dose	01/03/2022	$36.98
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	01/03/2022	$36.98
*These COVID-19 vaccine administration codes have been added for roster billing.

Effective January 3, 2022, OMS has also completed a system update to add the Pfizer COVID-19 pediatric third dose vaccine code. Please review the following table for more information.

COVID-19 Pfizer Pediatric Third Dose COVID-19 Vaccine Code
Code	Description	Effective Date	MaineCare Rate
0073A*	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, 10 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation; third dose	01/03/2022	$36.98
*This code is for the administration of the third dose of the Pfizer pediatric COVID-19 vaccine product identified by CPT code 91307 and has been added for roster billing.

Please contact your Provider Relations Specialist with questions.

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