COVID-19 Pfizer Vaccine Administration Procedure Codes – Update – 05/11/2021

On May 10, 2021, in accordance with the FDA’s issuance of Emergency Use Authorization for the Pfizer COVID-19 Vaccine, vaccine administration procedure codes 0001A and 0002A are benefits for Texas Medicaid for individuals age range has been updated. The Pfizer vaccine is now eligible for ages 12 years of age and older. Vaccine procedure code 91300 is informational only while the vaccine is distributed to providers free of charge.

Providers should reference the table below when submitting claims for vaccine administration:

Procedure codes 0001A and 0002A are benefits for the following providers and places of service:

Places of Service Provider Types
Office Physician Assistant, Nurse Practitioner, Clinical Nurse Specialist, Physician, Physician Groups, Certified Nurse Midwife, Pharmacist, CCP Provider, Nephrology (Hemodialysis, Renal Dialysis), Pharmacy, Clinic/Group Practice, Licensed Midwife, Registered Nurse, County Indigent Health Care Program
Outpatient Hospital Nephrology (Hemodialysis, Renal Dialysis), Hospital Providers, Renal Dialysis Facility
Home Physician Assistant, Nurse Practitioner, Clinical Nurse Specialist, Physician, Physician Groups, CCP Provider, Clinic/Group Practice
Other Locations Physician Assistant, Nurse Practitioner, Clinical Nurse Specialist, Physician, Physician Groups, CCP Provider, Clinic/Group Practice, County Indigent Health Care Program

Providers should reference the table below when submitting claims for the COVID-19 vaccine and vaccine administration:

Providers should bill CPT 91300 with a charge of $0.01 as this code is informational.  The Vaccines will Pay as follows beginning 4/1/2021:

**Rate subject to change based on TMHP notice**

CPT Code CPT Short Descriptor Labeler Name Vaccine Procedure Name Payment Allowance as of 4/1/2021
91300 SARSCOV2 VAC 30MCG/0.3ML IM Pfizer Pfizer-Biontech Covid-19 Vaccine $0.01
0001A ADM SARSCOV2 30MCG/0.3ML 1ST Pfizer Pfizer-Biontech Covid-19 Vaccine Administration – First Dose $40.00
0002A ADM SARSCOV2 30MCG/0.3ML 2ND Pfizer Pfizer-Biontech Covid-19 Vaccine Administration – Second Dose $40.00

COVID-19 Pfizer-BioNTech Vaccine Update – 05/10/2021

 

On December 11, 2020, the Food and Drug Administration (FDA) issued an Emergency Use Authorization (EUA) for the Pfizer-BioNTech COVID-19 Vaccine.  There are currently three different NDCs listed in drug databases like Mediaspan and First databank for the Pfizer COVID-19 vaccine.  However, one of those Pfizer NDCs is not yet available on the market.

  • HHSC has not added Pfizer NDC 59267-1000-03 to the Texas Medicaid formulary.
    • HHSC confirmed with the manufacturer the above NDC is for a 25 vial pack not commercially available at this time.

The following NDCs for Pfizer COVID-19 vaccines are currently covered on the Texas Medicaid Formulary for Medicaid and the Children’s Health Insurance Program (CHIP).

  • 59267-1000-01
  • 59267-1000-02

Reference code table below:

Providers should bill CPT 91300 with a charge of $0.01 as this code is informational.  The Vaccines will Pay as follows beginning 4/1/2021:

Visit our Coronavirus (COVID-19) page for the latest vaccine information, updates, and frequently asked questions.

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