Summary
The MA Program Vaccine Desk Reference lists the CPT codes and code descriptions on the MA Program Fee Schedule that are used for administering vaccines. It covers vaccines including respiratory syncytial virus, influenza, pneumococcal, hepatitis, meningococcal, zoster, rabies, and SARS-CoV-2 vaccines. The reference will be updated when new vaccine administration procedure codes are added to the fee schedule or when current procedure codes are updated.
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What to do
Action · 5 steps
01Providers who administer vaccines to MA beneficiaries may bill the MA Program for the administration using the CPT codes identified in the MA Program Vaccine Desk Reference.
02Providers may also bill the MA Program for a vaccine by indicating the appropriate National Drug Code and the units dispensed on the claim submission, using the Pharmacy Services Covered Drugs Search Tool.
03Providers may not bill or receive payment from the MA Program for the cost of a vaccine or its administration when it is available through other sources.
04Find billing instructions and information for specific MA-covered vaccines using the bulletin search on the Department's website.
05For managed care patients, address coding or rate-related questions to the appropriate MA managed care organization.
Codes mentioned
9038090381905819058590587905899061190619906209062190622906239062590626906279063090632906339063690647906489065190656906629067090671906729067490675906779067890679906809068190682906839068590686906879068890691906969069790698907009070290707907109071390714907159071690717907239073290734907369073890739907439074490746907479074990750907569075890759G0008G0009913049131891319913209132191322
Original notice
MAB2024012401
pa.gov · Always check the source before changing claims.
Related changes
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