​New Codes for Pfizer and Moderna Bivalent COVID-19 Vaccines, CR 118032

On April 18, 2023, the Food and Drug Administration (FDA) announced changes to simplify the use of Bivalent mRNA COVID-19 vaccines. As a result, additional CPT codes have been created by the American Medical Association (AMA) for use in billing for the administration of COVID-19 vaccines. The chart below indicates the CPT codes assigned to the vaccine and the new administration codes associated with them.  

   

Moderna Bivalent COVID-19 Vaccine -12 years and older  

Code  

Description  

Effective Date  

MaineCare Rate  

91313  

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, bivalent, preservative free, 50 mcg/0.5 mL dosage, for intramuscular use  

08/31/22  

$0*  

0134A  

Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, bivalent, preservative free, 50 mcg/0.5 mL dosage, additional dose  

08/31/22  

$39.11  

Moderna Bivalent COVID-19 Vaccine -6-11 years old  

Code  

Description  

Effective Date  

MaineCare Rate  

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  

10/12/22  

$0*  

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  

04/18/23  

$39.11  

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  

04/18/23  

$39.11  

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  

10/12/22  

$39.11  

Moderna Bivalent COVID-19 Vaccine -6 months to 5 years old  

Code  

Description  

Effective Date  

MaineCare Rate  

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  

12/08/22  

$0*  

0164A  

Immunization administration by intramuscular injection of 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, booster dose  

12/08/22  

$39.11  

  

Pfizer BioN-Tech Bivalent COVID-19 Vaccine -12 years and older  

Code  

Description  

Effective Date  

MaineCare Rate  

91312  

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  

08/31/22  

$0*  

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  

04/18/23  

$39.11  

0124A  

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; additional dose  

08/31/22  

$39.11  

Pfizer BioN-Tech Bivalent COVID-19 Vaccine – 5-11 years old  

Code  

Description  

Effective Date  

MaineCare Rate  

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  

10/12/22  

$0*  

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  

04/18/23  

$39.11  

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  

10/12/22  

$39.11  

Pfizer BioN-Tech Bivalent COVID-19 Vaccine – 6 months to 4 years old  

Code  

Description  

Effective Date  

MaineCare Rate  

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  

12/08/22  

$0  

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  

04/18/23  

$39.11  

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  

04/18/23  

$39.11  

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   

12/08/22  

$39.11  

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   

03/14/23  

$39.11  

*Government Supplied Vaccines  

**New CPT code for Bivalent COVID-19 vaccine administration  

Note: The COVID-19 vaccine administration codes will be added for roster billing  

    

Providers may visit the Maine CDC Immunization Program Website for up-to-date information on administering and ordering COVID-19 vaccines.     

If you have questions about the use of Bivalent COVID-19 vaccine booster doses, please contact your Provider Relations Specialist.   

 

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