TO: Hospital Providers, Physicians, Nurse Practitioners, Physician Assistants, Dentists, County Health Departments, Federally Qualified Health Centers, and Rural Health Clinics
RE: New Coverage for Administration of Moderna COVID-19 Vaccine (for Non-Pharmacy Providers)
Information in this Provider ALERT is in coordination with the ALERTs published January 11, 2021, March 24, 2021, and January 13, 2022.
Effective for dates of service on or after June 17, 2022, Medicaid covers the following procedure codes for the administration of the COVID-19 Moderna vaccine for Medicaid recipients.
Procedure Code Procedure Code Short Descriptor Age Restriction Medicaid Rate
0091A ADM SARSCOV2 50 MCG/.5 ML1ST 6y-11y $40.00
0092A ADM SARSCOV2 50 MCG/.5 ML2ND 6y-11y $40.00
0093A ADM SARSCOV2 50 MCG/.5 ML3RD 6y-11y $40.00
Procedure Code Procedure Code Short Descriptor Age Restriction Medicaid Rate
0111A ADM SARSCOV2 25MCG/0.25ML1ST 6mo-5y $40.00
0112A ADM SARSCOV2 25MCG/0.25ML2ND 6mo-5y $40.00
0113A ADM SARSCOV2 25MCG/0.25ML3RD 6mo-5y $40.00
Medicaid enrolled providers should not bill for the vaccine if using federally allocated vaccines.
To participate in the administration of COVID-19 vaccine, Alabama providers must enroll in the Alabama Department of Public Health (ADPH) ImmPRINT COVID-19 Vaccination Program. Follow the steps in the ImmPRINT Registration Roadmap to enroll.
Providers must follow state and federal laws and regulations regarding administration of the vaccine, as well as state and federal standing order guidelines for products granted Emergency Use Authorization (EUA).
Providers with billing questions should contact the Gainwell Technology Provider Assistance Center at
1-800-688-7989.
The Current Procedural Terminology (CPT) and Current Dental Terminology (CDT) codes descriptors, and other data are copyright © 2022 American Medical Association and © 2022 American Dental Association (or such other date publication of CPT and CDT). All rights reserved. Applicable FARS/DFARS apply.