NOTICES
DEPARTMENT OF HUMAN SERVICES
Medical Assistance Program Fee Schedule Updates for the Administration of SARS-CoV-2 Vaccines
[53 Pa.B. 7680]
[Saturday, December 9, 2023]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 bivalent doses of the novel coronavirus (SARS-CoV-2) vaccines manufactured by Pfizer, Inc. and Moderna, Inc., effective for dates of service between April 18, 2023, through September 12, 2023.
Vaccine
ManufacturerProcedure
CodeDescription MA Fee Pfizer, Inc. 0121A Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease (COVID-19)) vaccine, mRNA-LNP, bivalent spike protein, preservative free, 30 mcg/0.3 mL dosage, tris-sucrose formulation; single dose $40 0151A Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease (COVID-19)) vaccine, mRNA-LNP, bivalent spike protein, preservative free, 10 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation; single dose $40 0171A Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease (COVID-19)) vaccine, mRNA-LNP, bivalent spike protein, preservative free, 3 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation; first dose $40 0172A Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease (COVID-19)) vaccine, mRNA-LNP, bivalent spike protein, preservative free, 3 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation; second dose $40 Moderna, Inc. 0141A Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease (COVID-19)) vaccine, mRNA-LNP, spike protein, bivalent, preservative free, 25 mcg/0.25 mL dosage; first dose $40 0142A Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease (COVID-19)) vaccine, mRNA-LNP, spike protein, bivalent, preservative free, 25 mcg/0.25 mL dosage; second dose $40 The Department also announces the addition of the following procedure codes to the MA Program Fee Schedule for the administration of bivalent doses of the SARS-CoV-2 vaccines manufactured by Pfizer, Inc. and Moderna, Inc., effective for dates of service on and after September 11, 2023.
Vaccine
ManufacturerCode Code Description Rate Pfizer, Inc. 91318 Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease (COVID-19)) vaccine, mRNA-LNP, spike protein, 3 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation, for intramuscular use $40 91319 Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease (COVID-19)) vaccine, mRNA-LNP, spike protein, 10 mcg/0.2 mL dosage, tris-sucrose formulation, for intramuscular use $40 91320 Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease (COVID-19)) vaccine, mRNA-LNP, spike protein, preservative free, 3 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation, for intramuscular use $40 Moderna, Inc. 91321 Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease (COVID-19)) vaccine, mRNA-LNP, 25 mcg/0.25 mL dosage, for intramuscular use $40 91322 Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease (COVID-19)) vaccine, mRNA-LNP, 50 mcg/0.5 mL dosage, for intramuscular use $40 The Department announces the addition of the following procedure code to the MA Program Fee Schedule for the administration of the 2023-2024 Formula of the SARS-CoV-2 vaccine manufactured by Novavax, effective for dates of service on and after October 3, 2023.
Vaccine
ManufacturerCode Code Description Rate Novavax 91304 Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease (COVID-19)) vaccine, recombinant spike protein nanoparticle, saponin-based adjuvant, preservative free, 5 mcg/0.5 mL dosage, for intramuscular use $40 The MA Program Fee Schedule has been updated with the new procedure codes to allow for payment of the administration of the SARS-CoV-2 vaccines manufactured by Novavax, Pfizer, Inc. and Moderna, Inc.
Additionally, the Department end-dated the following procedure codes from the MA Program Fee Schedule, effective April 17, 2023, as the United States Food and Drug Administration (FDA) no longer authorizes the use of the monovalent SARS-CoV-2 vaccines noted as follows in the United States.
End-Dated CPT Codes 0001A 0002A 0003A 0004A 0011A 0012A 0013A 0021A 0022A 0031A 0034A 0051A 0052A 0053A 0054A 0064A 0071A 0072A 0073A 0074A 0081A 0082A 0083A 0091A 0092A 0093A 0094A 0111A 0112A 0113A The Department end-dated the following CPT codes from the MA Program Fee Schedule, effective June 1, 2023, as the FDA revoked the EUA for the SARS-CoV-2 vaccine manufactured by Janssen Biotech, Inc.
End-Dated CPT Codes 0031A 0034A The Department end-dated the following CPT codes from the MA Program Fee Schedule, effective September 12, 2023, as the FDA no longer authorizes the use of the bivalent SARS-CoV-2 vaccines identified as follows in the United States.
End-Dated CPT Codes 0121A 0124A 0134A 0141A 0142A 0144A 0151A 0154A 0164A 0171A 0172A 0173A 0174A The Department end-dated the following CPT codes from the MA Program Fee Schedule, effective October 3, 2023, as the Centers for Medicare & Medicaid Services closed the code.
End-Dated CPT Codes 0041A 0042A 0044A The Department will issue an MA Bulletin to enrolled providers to advise them of the changes to the MA Program Fee Schedule that are previously described.
Fiscal Impact
There is no fiscal impact associated with the addition of these procedure codes.
Public Comment
Interested persons are invited to submit written comments to the Department of Human Services, Office of Medical Assistance Programs, c/o Regulations Coordinator, P.O. Box 2675, Harrisburg, PA 17120 or at RA-PWMAProgComments@ pa.gov. Comments received within 30 days will be reviewed and considered for any subsequent revision of 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).
VALERIE A. ARKOOSH,
SecretaryFiscal Note: 14-NOT-1600. No fiscal impact; recommends adoption.
[Pa.B. Doc. No. 23-1701. Filed for public inspection December 8, 2023, 9:00 a.m.]
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