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Elizabeth M. Whitehorn, Director

Provider Notice Issued 04/04/2024

Date:   April 4, 2024

To:      Enrolled Pharmacies

Re:      COVID-19 Vaccine – Void/Rebill for Administration Fee

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This notice provides an update to pharmacies regarding billing for the COVID-19 vaccine administration fee. This update applies only to the Medicaid fee-for-service program for dates of service beginning September 11, 2023, through December 31, 2023.

A September 28, 2023, provider notice stated that the Department of Healthcare and Family Services (HFS) was still finalizing programming for the administration fee for the COVID-19 vaccine, and providers could not include administration fee charges on their claims at that time. Pharmacies could still provide COVID-19 vaccinations and submit claims to HFS for reimbursement for the cost of the vaccine and a professional dispensing fee, without an administration fee.

HFS has completed part of the programming for pharmacies to receive the applicable administration fee for COVID-19 vaccines. Pharmacies can now void and rebill claims that were initially submitted without the administration fee for dates of service beginning September 11, 2023, through December 31, 2023. Pharmacies must use “MA” in the Professional Service Code Field, in addition to identifying the administration fee.

Claims with dates of service beginning January 1, 2024, must continue to be billed without an administration fee until further notice.

Questions regarding this notice may be directed to a pharmacy consultant in the Bureau of Professional and Ancillary Services at 877-782-5565.

 

Kelly Cunningham, Administrator
Division of Medical Programs