MedicaidCoverageHigh impact
Newsletter Vol. 31, No.02
New Jersey Medicaid·NJ · Pharmacy, Family Medicine, General Practice +1 more·Provider Notice
Effective date
Jan 1, 2021
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid/NJ FamilyCare now reimburses pharmacies for administering SARS-CoV-2 vaccines at Medicare rates ($16.94 first dose, $28.39 second dose). Pharmacies must populate specific billing fields (420-DK with SCC codes "02" or "06", and 440-E5 with "MA") and report administration charges in the 438-E3 field. Claims without proper field population and the "MA" designation will be denied.
Action Required
Effective immediately, the billing team must: 1) Configure pharmacy billing system to populate the 420-DK field (Submission Clarification Code) with value "02" for first-dose SARS-CoV-2 vaccine administration claims and "06" for second-dose claims. 2) Configure the 440-E5 field (Professional Service Code) to automatically populate with value "MA" on all SARS-CoV-2 vaccine administration claims; claims submitted without "MA" will be denied (Error Code 2345). 3) Ensure the 438-E3 field (Incentive Amount Submitted) contains the administration fee amount ($16.94 or $28.39 depending on dose). 4) Program the billing system to enforce vaccine matching: reject second-dose claims if the NDC does not match the first dose NDC (Error Code 2347). 5) Program the billing system to enforce minimum dosing intervals: minimum 28 days for Moderna, 21 days for Pfizer (Error Code 2349). 6) Train pharmacy staff to update the New Jersey Immunization Information System (NJIIS) within 48 hours of vaccine administration and to check NJIIS before administration to avoid duplication. Failure to comply will result in claim denials under the specified error codes.