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BT202361: IHCP removes coverage for Pfizer and Moderna monovalent COVID-19 vaccine codes
Effective date
Apr 18, 2023
Identified
Jun 19, 2026
Summary
On April 18, 2023, the FDA announced that Emergency Use Authorization is no longer authorized for monovalent COVID-19 vaccines in the United States. Indiana Medicaid stopped reimbursing the Pfizer and Moderna monovalent COVID-19 vaccine and administration codes listed in Table 1 for dates of service on or after April 18, 2023. Claims that were paid for these codes for those dates of service will be reprocessed and payment will be recouped. The claim-processing system has been corrected, and affected claims will be mass reprocessed or mass adjusted as appropriate.
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What to do
Action · 4 steps
01Already effective April 18, 2023: The codes in Table 1 are noncovered for dates of service on or after April 18, 2023, so claims for these codes will not be reimbursed.
02Billing team: check Remittance Advices for reprocessed or adjusted claims, which providers should see beginning July 19, 2023, with internal control numbers or claim IDs that begin with 80 (reprocessed denied claim) or 52 (mass replacements non-check related).
03The codes will be updated in the next regular update to the Professional Fee Schedule and the Outpatient Fee Schedule.
04The codes will also be updated in these code tables: Family Planning Eligibility Codes, Physician-Administered Drugs Carved Out of Managed Care and Separately Reimbursed, Preventive Care Services for Healthy Indiana Plan and Presumptive Eligibility – Adult, Revenue Codes With Special Procedure Code Linkages, and Transportation Services Codes.
Codes mentioned
9130091301913059130691307913089130991311
Original notice
BT202361: IHCP removes coverage for Pfizer and Moderna monovalent COVID-19 vaccine codes
in.gov · Always check the source before changing claims.
Related changes
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