NOTICES

DEPARTMENT OF HUMAN SERVICES

Updates to Medical Assistance Program Fee Schedule for Administration of a Third Dose of SARS-CoV-2 Vaccines Manufactured by Pfizer, Inc. and Moderna, Inc.

[51 Pa.B. 6226]
[Saturday, September 25, 2021]

 In accordance with 55 Pa. Code § 1150.61(a) (relating to guidelines for fee schedule changes), the Department of Human Services (Department) announces the addition of the following procedure codes to the Medical Assistance (MA) Program Fee Schedule for the administration of a third dose of the novel coronavirus (SARS-CoV-2) vaccines manufactured by Pfizer, Inc. and Moderna, Inc. The effective date and MA Fee for each code is indicated as follows.

Vaccine Manufacturer	Procedure Code	Description	Effective Date	MA Fee
Pfizer, Inc.	0003A	Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease (COVID-19)) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3 mL dosage, diluent reconstituted; third dose	8/12/21	$40
Moderna, Inc.	0031A	Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease (COVID-19)) vaccine, mRNA-LNP, spike protein, preservative free, 100 mcg/0.5 mL dosage; third dose	8/12/21	$40

 The MA Program Fee Schedule has been updated with the new Current Procedural Terminology (CPT) codes to allow for payment of the administration of a third dose of the SARS-CoV-2 vaccines manufactured by Pfizer, Inc. and Moderna, Inc.

 The Department issued an MA Bulletin to enrolled providers to advise them of the addition of the CPT codes for the administration of a third dose of the SARS-CoV-2 vaccines manufactured by Pfizer, Inc. and Moderna, Inc. to the MA Program Fee Schedule.

Fiscal Impact

 The estimated fiscal impact of the addition of CPT codes for the administration of a third dose of SARS-CoV-2 vaccines manufactured by Pfizer, Inc. and Moderna, Inc. for Fiscal Year 2021-2022 is $33.770 million for managed care and $3.463 million for Fee-for-Service.

Public Comment

 Interested persons are invited to submit written comments regarding this notice to the Department of Human Services, Office of Medical Assistance Programs, c/o Regulations Coordinator, Room 515, Health and Welfare Building, Harrisburg, PA 17120. Comments received within 30 days will be reviewed and considered for any subsequent revision to the MA Program Fee Schedule.

 Persons with a disability who require an auxiliary aid or service may submit comments using the Pennsylvania Hamilton Relay Service at (800) 654-5984 (TDD users) or (800) 654-5988 (voice users).

MEG SNEAD, 
Acting Secretary

 Fiscal Note: 14-NOT-1464. No fiscal impact; (8) recommends adoption.

[Pa.B. Doc. No. 21-1629. Filed for public inspection September 24, 2021, 9:00 a.m.]

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