MedicaidBilling CodesMedium impact
MAB2021122802
Pennsylvania Medicaid (DHS)·PA · Family Medicine, Internal Medicine, Pediatrics +2 more·Provider Bulletin
Effective date
Sep 22, 2021
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance (Medicaid) has added three new CPT codes (0004A, 0034A, 0064A) for billing COVID-19 booster dose administration, with specific codes for Pfizer, Janssen, and Moderna vaccines. These codes are required for tracking purposes in both fee-for-service and managed care systems.
Action Required
Immediately: Update billing system to include new COVID-19 booster codes 0004A (Pfizer), 0034A (Janssen), and 0064A (Moderna) for Pennsylvania Medicaid claims. Use 0004A effective 9/22/2021, and 0034A/0064A effective 10/20/2021. For homebound patients, bill M0201 with the appropriate booster code. FQHCs and RHCs must bill T1015 for encounter visits plus the vaccine code on separate line. Cannot bill for federally-provided vaccines received at no cost.