Coverage of mNEXSPIKE (COVID-19 Vaccine, mRNA) for Medicare Advantage Members (Retroactively effective to August 27, 2025)

By October 13, 2025: Billing team must verify billing system recognizes mNEXSPIKE vaccine as covered for all Medicare Advantage members. Update claim submission protocols to ensure vaccine administration claims are processed without prior authorization delays. Clinical staff should verify member eligibility for vaccine coverage. Front desk should note this vaccine is covered with no cost-sharing for MA members. Review any denied claims from August 27, 2025 forward for mNEXSPIKE and resubmit if applicable. Consequence: Claims may be incorrectly denied or delayed if vaccine is not recognized as covered in billing system.