MedicaidCoverageMedium impact
Newsletter Vol. 32, No.17
New Jersey Medicaid·NJ · Optometry, Allergy & Immunology·Provider Notice
Effective date
Jun 1, 2022
We identified it
Jun 20, 2026
Summary
New Jersey optometrists who meet state Board requirements may now bill for administering COVID-19 and influenza vaccines to adults 18+. Influenza vaccine administration fees are included in the vaccine fee with no separate reimbursement. COVID-19 vaccine administration is reimbursed at $40.00 per dose using specific CPT codes; optometrists must enroll in the CDC COVID-19 Vaccination Program to legally store and administer COVID-19 vaccines.
Action Required
Immediately: (1) Billing team must verify which optometrists at the practice meet New Jersey State Board of Optometrists requirements for vaccine administration and maintain documentation of their qualifications. (2) Update billing system to enable billing for CPT codes 90662, 90672, 90674, 90682, 90686, 90688, 90694, and 90756 for influenza vaccines with NO separate administration fee (administration included in vaccine fee). (3) Providers and optometrists must enroll directly through the CDC COVID-19 Vaccination Program at https://www.cdc.gov/vaccines/covid-19/provider-enrollment.html before administering COVID-19 vaccines; verify enrollment status is complete. (4) Update billing system to enable COVID-19 vaccine administration billing using CPT codes 0001A, 0002A, 0003A, 0011A, 0012A, 0013A, 0004A, 0064A, 0034A, and 0031A at the fixed rate of $40.00 per dose (administration fee only; vaccine is government-supplied). (5) Train billing staff to only bill these codes when administered by enrolled, qualified optometrists during an active public health emergency. Non-compliance with enrollment requirements will result in claim denials and potential compliance violations. Contact Gainwell Technologies Provider Services at 1-800-776-6334 for billing questions or the Division of Medical Assistance at 609-588-2739 for policy questions.