COVID-19 Vaccine Information for Pharmacy Billing


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TO:   All Pharmacy Providers


RE:   COVID-19 Vaccine Information for Pharmacy Billing

Alabama Medicaid will allow reimbursement to pharmacies for a vaccine administration fee to Medicaid providers who utilize federally allocated COVID-19 vaccines. For claims effective March 15, 2021 and after, the reimbursement rate for the administration fee is $40.00 per dose and will continue only during that time as described by the American Rescue Plan Act of 2021 that provides for increased FMAP for administration of the COVID-19 vaccine unless ended sooner by the Agency in a subsequent ALERT. A booster dose will be allowed.

•    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. 
           o    Submit each vaccine with the specific approved vaccine NDC for an eligible recipient.
          o   Submit the administration fee in the Incentive Amount Submitted field (NCPDP Field 438-E3) on the same claim as the vaccine (i.e., ingredient).
           o    Medicaid will allow for vaccine/administration with an effective date on/after December 28, 2020.
           o    For claims on/after March 15, 2021, the administration fee is $40.00 per dose. 
         o   Vaccines must be administered according to approved labeling for appropriate ages and dosing interval.
         o   Effective August 13, 2021, providers may submit claims for a booster dose of mRNA vaccines in moderately to severely immunocompromised patients. Please refer to the CDC guidance for third dose here:
o   Booster doses of mRNA vaccines should be administered at least 28 days after the second dose.
      o   Claims for booster doses should be submitted with a Submission Clarification Code (SCC) (NCPDP Field 420-DK) of 07.
o   By entering a SCC of 07, the provider is attesting that the patient meets the requirement of being moderately to severely immunocompromised.

•    Per the Public Readiness and Emergency Preparedness (PREP) Act, either the Pharmacy or the Pharmacist NPI may be submitted on claims for COVID-19 vaccines only. 
           o    Claims for administration of COVID-19 vaccines with the Pharmacy or Pharmacist NPI submitted in the prescriber field should be submitted with a SCC of 42 indicating that the prescriber ID submitted is valid and prescribing requirements have been validated.

NCPDP Codes and Allowed Amounts for COVID-19 Vaccine Administration

Submission Clarification Code (440-E5)

Incentive Amount (Administration Fee 438-E3)

Ingredient Cost


Two Dose Vaccines

First Dose



$0.00 or $0.01

Second Dose



$0.00 or $0.01

Booster Dose



$0.00 or $0.01

Single-Dose Vaccines

Single Dose



$0.00 or $0.01

•    The payment rate for COVID-19 vaccine administration is $40.00 to administer any dose of the vaccine. As of March 15, 2021, the Submission Clarification Code indicating the first and second dose is being administered is no longer required. A SCC of 07 should be included on booster doses.

•    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.
          o    Moderna:
Moderna COVID-19 Vaccine: Standing Orders for Administering Vaccine to Persons 18 Years of Age and Older (
          o    Pfizer/BioNTech:
Pfizer-BioNTech COVID-19 Vaccine Standing Orders for Administering Vaccine (
          o    Janssen:
Janssen COVID-19 Vaccine (Johnson & Johnson): Standing Orders for Administering Vaccine to Persons 18 Years of Age and Older (

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

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