MedicaidBilling CodesMedium impact
Administration of the Pfizer-BioNTech COVID-19 Pre-Diluted Vaccine pdf
Connecticut Medicaid (HUSKY Health)·CT · Family Medicine, Internal Medicine, Pediatrics +1 more·Provider Bulletin
Effective date
Jan 3, 2022
We identified it
Jun 20, 2026
Summary
Connecticut Medicaid will reimburse $40.00 for administration of Pfizer-BioNTech COVID-19 Pre-Diluted vaccine (gray cap) for members 12+ years old, effective retroactively to January 3, 2022. New administration codes 0051A-0054A must be used for first, second, third doses and boosters respectively.
Action Required
Immediately: Update billing system to use administration codes 0051A (first dose), 0052A (second dose), 0053A (third dose), and 0054A (booster) for Pfizer-BioNTech COVID-19 Pre-Diluted vaccine administration for Connecticut Medicaid patients 12+ years old. Outpatient hospitals must also include vaccine product code 91305 with NDC and use Revenue Center Code 770. Pharmacy providers must use appropriate NCPDP Submission Clarification Codes.