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Indiana Medicaid (IHCP)Medicaid · Billing Codes · Pharmacy · INMedium impact

BT2023132: IHCP announces COVID-19 vaccine pharmacy benefit updates for 2023-2024 season

Act
by Oct 1, 2023
Effective date
Sep 11, 2023
Identified
Jun 19, 2026

Summary

Indiana Medicaid (IHCP) will now reimburse pharmacies for updated 2023-2024 Moderna and Pfizer COVID-19 vaccines effective September 11, 2023, as these are no longer available free from government stock. Billing procedures change October 1, 2023 - pharmacies must stop using Service Clarification Code 420-DK and submit only Professional Service Code 440-E5 with MA for administration fees.

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What to do

by Oct 1, 2023 · 4 steps
01Billing team must update pharmacy billing procedures to stop using Service Clarification Code (420-DK) for COVID-19 vaccine claims.
02Continue using Professional Service Code (440-E5) with MA for administration fees only.
03VFC-enrolled pharmacies receive $15.00 administration fee, non-VFC enrolled receive $38.75.
04Claims submitted between Sept 11-Oct 5 with old codes can be reprocessed for reimbursement.

Original notice

BT2023132: IHCP announces COVID-19 vaccine pharmacy benefit updates for 2023-2024 season
in.gov · Always check the source before changing claims.
View original ↗

Related changes

See all Indiana Medicaid (IHCP) changes →
BT2020127: IHCP to reimburse pharmacy providers for COVID-19 vaccine administrationMediumEffective Dec 15, 2020 · PharmacyBT202218: IHCP to cover additional COVID-19 vaccine and administration codesMediumEffective Jan 3, 2022 · Provider BulletinBT202224: Pharmacy claim processing clarified for administration of third and booster doses of COVID-19 vaccineMediumEffective Apr 1, 2022 · PharmacyBT202267: IHCP to cover Novavax COVID-19 vaccine and administrationMediumEffective Jul 13, 2022 · Provider BulletinBrowse every Indiana Medicaid (IHCP) change in the policy list

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