Pfizer and Moderna Bivalent COVID-19 Vaccines Authorized to Use as Booster Doses in Children Ages 5 Years and Older
On October 17, 2022, the Office of MaineCare Services (OMS) sent an announcement that we will cover the Pfizer and Moderna bivalent COVID-19 vaccine booster doses as outlined in Emergency Use Authorizations (EUA) from the Food and Drug Administration (FDA).
OMS has completed the update to our systems, and you may begin to submit claims for these services.
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Moderna COVID-19 Vaccine Bivalent Booster- Children 12 years and older |
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Code |
Description |
Effective Date |
MaineCare Rate |
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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 |
10/12/22 |
$0* |
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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, booster dose |
10/12/22 |
$36.98 |
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Moderna COVID-19 Vaccine Bivalent Booster-6 to 11 years old |
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91314 |
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 |
10/12/22 |
$0* |
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0144A |
Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRN-LNP, spike protein, bivalent, preservative free, 25 mcg/0.25 mL dosage, booster dose |
10/12/22 |
$36.98 |
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Pfizer BioN-Tech COVID-19 Vaccine Bivalent Booster- 5 to 11 years old |
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Code |
Description |
Effective Date |
MaineCare Rate |
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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* |
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0154A |
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, 10 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation, booster dose |
10/12/22 |
$36.98 |
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*Government Supplied Vaccines +Code previously released 08/31/22 for 18+ Note: The COVID-19 vaccine administration codes will be added for roster billing |
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Please be reminded that this authorization replaces the prior EUAs for the Monovalent COVID-19 vaccine booster dose from Pfizer BioN-Tech for individuals ages five and older.
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No Longer Authorized-Pfizer BioN-Tech COVID-19 Vaccine Booster-5 to 11 years old |
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Code |
Description |
Effective Date |
End Date |
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91307 |
Pfizer-BioNTech- Severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 10 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation, for intramuscular use |
10/29/21 |
10/12/22* |
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0074A |
Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARSCoV- 2) (coronavirus disease [COVID-19]) vaccine, mRNALNP, spike protein, preservative free, 10 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation; booster dose |
05/17/22 |
10//12/22 |
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*Drug is only authorized for use with a Primary Dose Covid Vaccine Series. Do not use this drug code when billing booster doses for the age ranges specified. |
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Providers may visit the Maine CDC Immunization Program Website for up-to-date information on administering and ordering COVID-19 vaccine and booster doses.
If you have questions about the use of Monovalent or Bivalent COVID-19 vaccine booster doses, please contact your Provider Relations Specialist.
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