NOTICES
DEPARTMENT OF HUMAN SERVICES
Administration of Booster Dose of SARS-CoV-2 Vaccines and Third Dose of the Moderna, Inc. SARS-CoV-2 Vaccine
[52 Pa.B. 424]
[Saturday, January 15, 2022]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 booster dose of the novel coronavirus (SARS-CoV-2) vaccines manufactured by Pfizer, Inc., Janssen Biotech, Inc. and Moderna, Inc. The effective dates and MA Fee for the codes are indicated as follows.
Vaccine Manufacturer Procedure Code Description Effective Date MA
FeePfizer, Inc. 0004A 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; booster dose9/22/21 $40 Janssen Biotech, Inc. 0034A Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease (COVID-19)) vaccine, DNA, spike protein, adenovirus type 26 (Ad26) vector, preservative free, 5×1010 viral particles/0.5 mL dosage; booster dose 10/20/21 $40 Moderna, Inc. 0064A 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, 50 mcg/
0.25 mL dosage, booster dose10/20/21 $40 The MA Program Fee Schedule has been updated with the new Current Procedural Terminology (CPT) code to allow for payment of the administration of a booster dose of the SARS-CoV-2 vaccines manufactured by Pfizer, Inc., Janssen Biotech, 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 booster dose of the SARS-CoV-2 vaccines manufactured by Pfizer, Inc., Janssen Biotech, Inc. and Moderna, Inc. to the MA Program Fee Schedule.
In addition, this notice corrects a typographical error that appeared in the public notice, ''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.'', published at 51 Pa.B. 6226 (September 25, 2021). The procedure code for the third dose of the Moderna, Inc. SARS-CoV-2 vaccine is 0013A, as is reflected in the MA Program Fee Schedule.
Fiscal Impact
The estimated fiscal impact of the addition of the CPT code for the administration of a booster dose of the SARS-CoV-2 vaccines 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 SecretaryFiscal Note: 14-NOT-1482. No fiscal impact; (8) recommends adoption.
[Pa.B. Doc. No. 22-96. Filed for public inspection January 14, 2022, 9:00 a.m.]
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