COVID-19 Vaccine Administration Codes 0081A, 0082A, 0083A, 0111A, 0112A, 0113A, Are Now Benefits for Medicaid and CHIP

August 19, 2022

What is New

For dates of service on or after June 17, 2022, the U.S Food and Drug Administration (FDA) issued an Emergency Use Authorization (EUA) of the Pfizer-BioNTech and Moderna vaccines. The following are the age requirements for these procedure codes:

• Procedure codes 0081A, 0082A, and 0083A are used to report the administration of the first, second, and third doses of the primary series of the Pfizer COVID-19 vaccine to children 6 months through 4 years of age.
• Procedure codes 0111A, 0112A, and 0113A are used to report the administration of the first and second doses of the primary series and the third dose of the Moderna COVID-19 vaccine to children 6 months through 5 years of age.
  

Vaccine procedure codes 91308 (Pfizer-BioNTech) and 91311 (Moderna) are informational only, while the vaccine is distributed to the provider free of charge.

Reimbursement

We won't reimburse for Pfizer-BioNTech or Moderna COVID-19 vaccines that providers received for free. Providers should not charge members for these vaccines. We will reimburse for the administration of the vaccines. Other medically necessary treatment for COVID-19 will be covered consistent with the terms of the member's benefit plan. You can also reference the CMS Medicaid toolkit for more details.

Claims Reprocessing

Claims with procedure codes 0081A, 0082A, 0083A, 0111A, 0112A, and 0113A with dates of service on or after June 17, 2022, must be reprocessed for appropriate payment. Blue Cross and Blue Shield of Texas (BCBSTX) does not require providers to submit an appeal unless they are denied for other reasons after the claims reprocessing is complete.

Vaccine Administration claims submission information:

0081A, 0082A, 0083A, 0111A, 0112A, 0113A are Medicaid and CHIP benefits for the following Providers and Places of Service (POS):

• Office: County Indigent Health Care Program, Physician Group, Physician Assistant, Nurse Practitioner, Clinical Nurse Specialist, Physician, Pharmacist, Certified Nurse Midwife, Registered Nurse/Licensed Midwife, Federally Qualified Healthcare Centers, Comprehensive Care Program Provider, Nephrology (Hemodialysis, Renal Dialysis, Rural Health Clinics (Freestanding/Independent and Hospital-based), Pharmacy
• Home: Physician Groups, Physician Assistant, Nurse Practitioner, Clinical Nurse Specialist, Physician, Home Health Agency, Comprehensive Care Program Provider
• Outpatient Hospital: Federally Qualified Healthcare Centers, Hospitals, Nephrology (Hemodialysis, Renal Dialysis), Renal Dialysis Facility, Rural Health Clinics (Freestanding/Independent and Hospital-based)
• Other Locations: County Indigent Health Care Program, Physician Assistant, Physician Group, Nurse Practitioner, Clinical Nurse Specialist, Physician, Federally Qualified Healthcare Centers, Comprehensive Care Program Provider

Resources

Providers interested in enrolling  as COVID-19 vaccinators

CMS Medicaid Toolkit - Coverage and Reimbursement of COVID-19 Vaccines, Vaccine Administration and Cost Sharing under Medicaid, the Children’s Health Insurance Program, and Basic Health Program

Article regarding the FDA Authorizes Moderna and Pfizer-BioNTech vaccines for children down to 6 months of age

Questions

Providers, for questions or additional information, please:

• Contact your BCBSTX Medicaid Network team at 1-855-212-1615 or
• Submit via email Texas Medicaid Network Department

The above material is for informational purposes only and is not a substitute for the independent medical judgment of a physician or other health care provider. Physicians and other health care providers are encouraged to use their own medical judgment based upon all available information and the condition of the patient in determining the appropriate course of treatment. References to other third-party sources or organizations are not a representation, warranty or endorsement of such organization. Any questions regarding those organizations should be addressed to them directly. The fact that a service or treatment is described in this material is not a guarantee that the service or treatment is a covered benefit and members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions. Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider.