MedicaidBilling CodesMedium impact
MAB2021123001
Pennsylvania Medicaid (DHS)·PA · Pharmacy, Family Medicine, Pediatrics +1 more·Provider Bulletin
Effective date
Nov 1, 2021
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid will now reimburse pharmacies $10.00 for vaccine administration by licensed pharmacists, effective November 1, 2021. Pharmacies must bill using CPT codes 90471 for the first vaccine and 90472 for additional vaccines on the same day.
Action Required
Immediately: Inform any affiliated pharmacies that they can now bill Pennsylvania Medicaid for vaccine administration using CPT 90471 ($10.00) for first vaccine and CPT 90472 ($10.00) for each additional vaccine same day. Pharmacies must use 837P claim format with their NPI as billing/rendering provider. Cannot bill for VFC-eligible vaccines for patients under 19. Note: This does not apply to COVID-19 vaccines which have separate billing codes.