MedicaidBilling CodesMedium impact
PB 2021-89 - Booster Doses COVID-19 Vaccine Administration pdf
Connecticut Medicaid (HUSKY Health)·CT·Provider Bulletin
Effective date
Sep 22, 2021
We identified it
Jun 20, 2026
Summary
Connecticut Medicaid (HUSKY Health) will reimburse $40.00 for COVID-19 booster dose administration using new procedure codes 0004A (Pfizer), 0064A (Moderna), and 0034A (Janssen). Coverage applies to eligible individuals based on FDA Emergency Use Authorization criteria through the end of the federal public health emergency.
Action Required
Immediately: Update billing system to include new COVID-19 booster administration codes 0004A (Pfizer, effective 9/22/2021), 0064A (Moderna, effective 10/20/2021), and 0034A (Janssen, effective 10/20/2021) with $40.00 reimbursement rate for Connecticut Medicaid patients. Outpatient hospitals must include appropriate vaccine product codes (91300, 91306, 91303) with Revenue Center Code 770. Pharmacy providers must use NCPDP Submission Clarification Code 10 for booster dose claims.