MedicaidBilling CodesHigh impact
January 2021 Medicaid Information Bulletin
Utah Medicaid·UT · Pharmacy·Government Programs
Effective date
Jan 1, 2021
We identified it
Jun 21, 2026
Summary
Utah Medicaid has updated COVID-19 billing guidance effective January 1, 2021, including specific vaccine administration codes and reimbursement rates of $22.67 per dose, copayment waivers with CS modifier requirements, and coverage for new COVID-19 testing codes. The policy provides detailed billing instructions for both pharmacy point-of-sale and medical claims for COVID-19 vaccines and related services.
Action Required
Immediately: Update billing system to include new COVID-19 vaccine codes 91300 and 91301 with corresponding administration codes (0001A, 0002A, 0011A, 0012A) and set reimbursement rate at $22.67 per administration. Add CS modifier to all COVID-19 related claims to waive copayments. Program new COVID-19 testing codes (87635, 87636, 87637, 87426, 87811, 86769, 86413, 86408, 86409, 86328) for coverage. Train billing team on pharmacy point-of-sale requirements including proper NDC coding and submission clarification codes for initial vs. subsequent vaccine doses.