MedicaidBilling CodesMedium impact
MAB2023041301
Pennsylvania Medicaid (DHS)·PA · Family Medicine, Internal Medicine, Pediatrics +2 more·Provider Bulletin
Effective date
Dec 8, 2022
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance (Medicaid) has added two new CPT codes (0164A for Moderna and 0173A for Pfizer) for billing additional bivalent COVID-19 vaccine administration. These codes are effective for dates of service on or after December 8, 2022, with a reimbursement rate of $40.00.
Action Required
Immediately: Billing team must add CPT codes 0164A (Moderna) and 0173A (Pfizer) to billing system for Pennsylvania Medicaid COVID-19 bivalent vaccine administration at $40.00 reimbursement rate. Update encounter forms for eligible provider types. For homebound patients, bill M0201 alongside vaccine codes. FQHCs and RHCs use T1015 for encounters with other services and separate vaccine code line for tracking.