Administration of COVID-19 Investigational Drugs, Vaccines, Devices and Associated Services
For questions regarding coverage and reimbursement, please call the South Country Health Alliance Provider Contact Center at 1-888-633-4055. You may also access additional detail on COVID-19 coverage at Minnesota Department of Human Resources Minnesota Health Care Programs MHCP Provider Manual (external link) and CMS https://www.cms.gov/About-CMS/Agency-Information/Emergency/EPRO/Current-Emergencies/Current-Emergencies-page (external link).
Effective November 11, 2020, the Minnesota Department of Human Services (DHS) commissioner approved Medical Assistance and MinnesotaCare members to receive coverage for investigational drugs, vaccines, devices and associated services that receive Federal approval under an Emergency Use Authorization (EUA) to treat or prevent COVID-19. However, current State law prohibits Medical Assistance and MinnesotaCare coverage for investigational drugs, vaccines, devices and associated services not related to COVID-19. This change does the following:
- It allows the State to reimburse health care providers for the associated services of administering the drug, including the office visit and monitoring time.
- It ensures coverage for any COVID-19 vaccines that are currently approved under a Federal Emergency Use Authorization.
- It ensures Minnesota receives the enhanced Federal funding available under the Families First Coronavirus Response Act by meeting the requirement for Medicaid agencies to cover all COVID-19 treatments.
Providers may not seek reimbursement for any investigational drug, vaccine, or device that a Federal distribution program provides at no cost.
The change will continue through the end of the quarter in which the Federal public health emergency ends.
For the most current information and status, please call the South Country Health Alliance Provider Contact Center at 1-888-633-4055.
The table COVID-19 Vaccine was last modified 03/08/2023
| CPT Vaccine Code | Vaccine Description | Eligible Ages | CPT Administration Code | Effective Date | Vaccine Administration Description |
|---|---|---|---|---|---|
| 91300 | SARSCOV2 VAC 30MCG/0.3ML IM Pfizer-Biontech COVID-19 Vaccine | 16 years and older Effective 05/10/2021: 12 years and older | 0001A - First dose | 12/11/2020 | Report for the administration of vaccine 91300 (Pfizer-Biontech) only: 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/0.3mL dosage, diluent reconstituted |
| 0002A - Second dose | 12/11/2020 | ||||
| 0003A - Third dose | 8/12/2021 | ||||
| 0004A - Booster dose | 9/22/21 | ||||
| 91307 | SARSCOV2 VAC Pfizer-BioNTech 10 mcg/0.2 mL Pfizer-BioNTech COVID-19 Vaccine | 5-11 years old | 0071A - First dose | 10/29/2021 | Report for the administration of vaccine 91307 (Pfizer-Biontech) only: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 10 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation, for intramuscular use |
| 0072A - Second dose | 10/29/2021 | ||||
| 0073A - Third dose | 1/3/2022 | ||||
| 0074A - Booster dose | 5/17/2022 | ||||
| 91305 | SARSCOV2 VAC 30 MCG TRS-SUCR Pfizer-Biontech COVID-19 Vaccine (Ready to Use) | 12 years and older | 0051A - First dose | 2/1/2022 | Report for the administration of vaccine 91305 (Pfizer-Biontech) only: 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, tris-sucrose formulation; 30 mcg/0.3 mL dosage |
| 0052A - Second dose | |||||
| 0053A - Third dose | 2/1/2022 | ||||
| 0054A - Booster dose (For emergency use only of individuals 18 years & older) | 2/1/2022 | ||||
| 91308 | SARS-CoV-2 VAC 3 mcg/0.2 ml IM Pfizer-BioNTech COVID-19 Vaccine | 6 months-4 years old | 0081A - First dose | 6/17/2022 | Report the administration of vaccine only for 91308 (Pfizer-BioNTech): Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (coronavirus disease [COVID-19]) vaccine, mRNALNP, spike protein, preservative free, 3 mcg/0.2 ml dosage |
| 0082A - Second dose | |||||
| 0083A - Third dose | |||||
| 91312 | SARS-CoV-2 VAC BVL 30 mcg/0.3 ml Pfizer-BioNTech COVID-19 Vaccine | 12 years and older | 0124A - Single booster | 8/31/2022 | Report the administration of vaccine only for 91312 (Pfizer-BioNTech): 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 |
| 91315 | SARS-CoV-2 VAC 10MCG/0.2ML Pfizer-BioNTech COVID-19 Vaccine | 5-11 years old | 0154A - Single booster | 10/12/2022 | Report the administration of vaccine only for 91315 (Pfizer-BioNTech): 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, tris-sucrose formulation |
| 91317 | SARS-CoV-2 VAC 3MCG/0.2ML Pfizer-BioNTech COVID-19 Vaccine | 6 months - 4 years old | 0173A - Single booster | 12/8/2022 | Report the administration of vaccine only for 91317 (Pfizer-BioNTech): 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, tris-sucrose formulation |
| 91301 | SARSCOV2 VAC 100MCG/0.5ML IM Moderna COVID-19 Vaccine | 12 years and older | 0011A - First dose | 12/18/2020 | Report for the administration of vaccine 91301 (Moderna) only: 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, 100mcg/0.5mL dosage |
| 0012A - Second dose | 8/12/2021 | ||||
| 0013A - Third dose | 8/12/2021 | ||||
| 91306 | SARSCOV2 VAC 50 mcg/0.25 mL IM Moderna COVID-19 Vaccine | 65 years and older; and others with certain conditions | 0064A - Single booster dose | 10/20/2021 | Report for the administration of vaccine 91306 (Moderna) only: 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 dose |
| 91309 | SARSCOV2 VAC 50 mcg/0.5 mL IM Moderna COVID-19 Vaccine | 6-11 years old | 0091A - First dose | 6/17/2022 | Report for the administration of vaccine 91309 (Moderna) only: 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/0.5 mL dosage |
| 0092A - Second dose | |||||
| 0093A - Third dose | |||||
| 91311 | SARSCOV2 VAC 25 mcg/0.25 mL IM Moderna COVID-19 Vaccine | 6 months-5 years old | 0111A - First dose | 6/17/2022 | Report for the administration of vaccine 91311 (Moderna) only: 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, 25 mcg/0.25 mL dosage |
| 0112A - Second dose | |||||
| 0113A - Third dose | |||||
| 91313 | SARSCOV2 VAC 50 mcg/0.5 mL Moderna COVID-19 Vaccine | 18 years and older | 0134A - Single booster | 8/31/2022 | Report the administration of vaccine only for 91313 (Moderna): 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, 50 mcg/0.5 mL dosage |
| 91314 | SARSCOV2 VAC BVL 25mcg/0.25 mL Moderna COVID-19 Vaccine | 6-11 years old | 0144A - Single booster | 10/12/2022 | Report the administration of vaccine only for 91314 (Moderna): 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 |
| 91303 | SARSCOV2 VAC 5x1010/.05mL IM Johnson & Johnson (Janssen) COVID-19 Vaccine | 18 years and older | 0031A - Single dose | 2/27/2021 | Report for the administration of vaccine 91303 (Janssen) only: 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, 5x1010 viral particles/0.5mL dosage |
| 0034A - Booster dose | 10/20/2021 | ||||
| 91304 | SARSCOV2 VAC 5MCG/0.5ML IM Novavax Covid-19 Vaccine | 12 years and older | 0041A - First dose | 7/13/2022 | Report for the administration of vaccine 91304 (Novavax) only: Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine |
| 0042A - Second dose | |||||
| 0044A - Booster dose | 10/19/2022 |
Effective June 8th, 2021, Report code M0201 for COVID-19 vaccine administration inside a patient's home; reported only once per individual home per date of service when the sole reason for the visit to the patient’s home is administration of the COVID-19 vaccine
COVID-19 and Pediatric Vaccine Administration
The Public Readiness and Emergency Preparedness (PREP) Act authorizes pharmacists to order and administer pediatric vaccines and COVID-19 vaccines for children ages 3 – 18 during the public health emergency. The Minnesota Board of Pharmacy has issued guidance about this change and the professional requirements surrounding the newly expanded authority for pharmacists in their COVID-19 Section https://mn.gov/boards/assets/2020_Minnesota_Legislation_Affecting_Pharmacy_tcm21-440503.pdf (pdf). As a result of the PREP Act, DHS will reimburse pharmacists for ordering and administering pediatric vaccines and COVID-19 vaccines consistent with the PREP Act requirements. Review the Pharmacists Ordering and Administering COVID-19 and Pediatric Vaccines (external link) section of the Minnesota Health Care Programs (MHCP) Provider Manual for billing information.
Billing for Enrolled Pharmacists Ordering and Administering COVID-19 and Pediatric Vaccines
Claims for administering COVID-19 vaccines and pediatric vaccines for children ages 3 – 18 must be billed on a 837P professional claim using the enrolled pharmacist’s National Provider Identifier (NPI) as the ordering and rendering provider and the pharmacy’s NPI as the pay-to provider. If a pharmacy has any billing questions billing medical claims to South Country, please call the South Country Provider Contact Center at 1-888-633-4055. Pharmacists providing vaccines to children eligible for free vaccines through the Minnesota Vaccines for Children (MnVFC) program must enroll with the MnVFC program and provide the vaccines at no cost. Pharmacists are not allowed to seek reimbursement for any vaccine that is provided at no cost through a Federal distribution program; however, the cost for the administration of the vaccines is reimbursable.
Note: the COVID-19 vaccines approved by the Food and Drug Administration under an Emergency Use Authorization are not currently being distributed through the MNVFC program. Pharmacists providing only the COVID-19 vaccine to MHCP members are not required to enroll with the MNVFC program for the COVID-19 vaccine.
Providers Who Can Bill for Administering COVID-19 Vaccines
The following MHCP-enrolled provider types are eligible to bill for the administration of COVID-19 vaccines:
- Dentist
- Federally Qualified Health Center (FQHC)
- Home Health Agency
- Hospice
- Hospital
- Indian Health Facility Provider
- Nurse Midwife
- Nurse Practitioner
- Optometrist
- Pharmacy
- Physician
- Physician Assistant
- Podiatrist
- Public Health Clinic
- Public Health Nursing Organization
- Rehabilitation Agency
- Renal Dialysis Free Standing
- Rural Health Clinic (RHC)
COVID-19 Vaccine Counseling
Effective January 1, 2022, South Country covers vaccine counseling. Providers may counsel for COVID-19 vaccinations and standard vaccines. Counseling may be provided both in-person and via telehealth. Providers billing for vaccine counseling services must have the ability to administer the vaccine for which they are counseling. Providers cannot bill for vaccine counseling separately if the counseling is a required component of another service provided in the same visit.
Bill only one counseling session for each member per day, but there is no limit to the number of times counseling may be provided to an individual. Use the appropriate CPT/HCPCS code for the vaccine counseling and use modifier “CR” when counseling specifically for COVID-19.
Employee Covid-19 Vaccination Requirement
In light of the recent Supreme Court ruling on January 13, 2022, employee vaccination requirements from the Centers for Medicare & Medicaid Services (CMS) now apply to certain Medicare or Medicaid providers and suppliers. Please see below for new and updated tools and resources developed by CMS to help you navigate and determine if these vaccine requirements apply to you. These materials are all available from the CMS Current Emergencies page:
- Guidance memo (cms.gov) – This memo provides guidance for assessing and maintaining compliance with this new regulatory requirement for certain Medicare and Medicaid providers and suppliers.
- CMS Omnibus COVID-19 Health Care Staff Vaccination Requirements FAQ (PDF cms.gov) (PDF) – These FAQs have been updated to explain the recent ruling and how it impacts employee vaccination requirements.
- IFC-6 Vaccination Requirements Infographic (cms.gov) (PDF) – This infographic visually shows the types of providers and suppliers the vaccine requirement applies to, how the requirement can be met, and associated requirement enforcement actions.
- Vaccine Requirement Implementation Timeline (cms.gov) (PDF) – This infographic illustrates the phases of the vaccination rule implementation, state-by-state, and their associated deadlines. Note that the phased deadlines vary by state.
- Vaccine Requirement Decision Tree (cms.gov) (PDF) – This handy decision tree visually explains the steps in determining to which providers and suppliers the vaccine requirement applies.
Last Updated on 08/18/2022 by Nikita Woltersen