DHHS → Office of MaineCare Services (OMS) → Provider Resources → Pfizer and Moderna COVID-19 Bivalent Vaccine Authorized for use in individuals aged Six Months to Five Years

Pfizer and Moderna COVID-19 Bivalent Vaccine Authorized for use in individuals aged Six Months to Five Years

Dec 16, 2022

In a December 8, 2022, announcement, the Food and Drug Administration (FDA) issued Emergency Use Authorization (EUA) for the use of Bivalent COVID-19 Vaccines from Pfizer BioN-Tech to be used as the third dose of the three dose primary series for ages six months to four years. Children who have already received their third dose will not be eligible to receive a bivalent dose at this time.

On this same day, an EUA was issued for Moderna as a booster dose for individuals ages six months to five years who have already completed the Moderna two dose monovalent COVID-19 vaccine primary series.

The Office of MaineCare Services (OMS) will be updating our system to include the codes listed in the table below. We are asking providers to hold all claims for these COVID-19 vVaccine doses and their administration for this age group until this system update is complete.

Moderna COVID-19 Bivalent Vaccine Booster- 6 months to 5 years
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 (SARSCoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, bivalent, preservative free, 10 mcg/0.2 mL dosage, booster dose	12/08/22	TBD**
Pfizer BioN-Tech COVID-19 Bivalent Vaccine Third Dose in Primary Series- 6 months to 4 years
Code	Description	Effective Date	MaineCare Rate
91317	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	12/08/22	$0*
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	08/31/22	TBD**
Government Supplied Vaccines *Rates for these codes are not yet established 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 vaccine and booster doses. The Maine CDC Immunization Program also released this bulletin related to the allowable uses for this age group.

If you have questions about the use of Monovalent or Bivalent COVID-19 vaccines, 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.