Alerts

COVID-19 Vaccine Information for Pharmacy Billing

12/28/2020


TO:    All Pharmacy Providers

 

RE:   COVID-19 Vaccine Information for Pharmacy Billing

 

 

Alabama Medicaid will allow vaccine administration fee reimbursement to Medicaid participating providers for federally-allocated COVID-19 vaccines.

 

  • Pharmacies will bill vaccines through an electronic NCPDP claim.

o Submit $0.00 or $0.01 for vaccine provided at no cost from the federal government. 

    • Submit each vaccine with the specific approved vaccine NDC for an eligible recipient.
    • Submit the administration fee in the Incentive Amount Submitted field (NCPDP Field 438-E3) on the same claim as the vaccine (i.e., ingredient).
    • Medicaid will allow for vaccine/administration with an effective date on/after 12/28/2020.
    • Vaccines must be administered according to approved labeling for appropriate ages and dosing interval.

 

       NCPDP Codes and Allowed Amounts for COVID-19 Vaccine Administration


Submission Clarification Code

(440-E5)

Incentive Amount (Administration Fee 438-E3)

Ingredient Cost

(409-D9)

Two-Dose Vaccines




First Dose

02

$16.94

$0.00 or $0.01

Second Dose

06

$28.39

$0.00 or $0.01

Single-Dose Vaccines




Single Dose

blank

$28.39

$0.00 or $0.01

 

 

  • The payment rate for COVID-19 vaccine administration is $28.39 to administer single-dose vaccines.
    • For single-dose vaccine claims, the Submission Clarification Code (SCC) should remain blank.
  • The payment rate for a COVID-19 vaccine administration requiring a series of two or more doses is $16.94 for the initial dose, and $28.39 for the administration of the final dose in the series.
    • For multi-dose vaccines, submit 02 (other override) for the initial dose in the SCC field.
    • For the second dose, submit 06 (the previous medication was a starter dose and now additional medication is needed to continue treatment) in the SCC field.
  • To participate in the administration of COVID-19 vaccine, Alabama providers must enroll in the Alabama Department of Public Health’s (ADPH) ImmPRINT COVID-19 Vaccination Program. Follow the steps in the ImmPRINT Registration Roadmap to enroll. 
  • Pharmacies must follow state and federal laws and regulations regarding administration of vaccines.
  • State and federal standing order guidelines for products granted Emergency Use Authorization (EUA) must be followed. Standing order guidelines can be found at the links below.

 Moderna: https://www.alabamapublichealth.gov/immunization/assets/covid19_moderna_standingorders.pdf


 Pfizer/BioNTech: https://www.alabamapublichealth.gov/immunization/assets/covid19_pfizervaccine_standingorders.pdf

 

Pharmacy providers with questions regarding vaccine administration may call the Alabama Medicaid Pharmacy Program at (334) 242-5050.