MaineCare Pediatric COVID-19 Vaccine Administration and Vaccine Counseling: Please Hold Claims Pending Further Billing Guidance

Jul 01, 2022

Effective June 17, 2022, the Food and Drug Administration 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 will be updating its claims system in the coming weeks to include the codes for these services. Please hold on submitting claims for Pfizer-BioNTech COVID-19 vaccines administered to members ages 6 months to 4 years, and Moderna COVID-19 vaccines administered to members ages 6 months to 5 years, until the system update is complete. We will send another message when the system update is complete.   

Please see the COVID-19 Vaccination Update document for code information on MaineCare coverage for COVID-19 vaccines in general. 

In addition, providers should continue to hold on submitting claims for COVID-19 vaccine counseling as requested in our June 16, 2022, message. 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, 7, 14, 40, 45, and 90 retroactive to April 1, 2021. MaineCare is currently awaiting effective dates and pricing, and will update its systems once CMS provides further guidance. We will send another message when the system update is complete.   

Please contact your Provider Relations Specialist with questions.