MedicaidCoverageMedium impact
BT202272: IHCP announces update to Novavax COVID-19 vaccine pharmacy claim reimbursement
Indiana Medicaid (IHCP)·IN · Family Medicine, Internal Medicine, Pediatrics·Pharmacy
Effective date
Aug 19, 2022
We identified it
Jun 19, 2026
Summary
Indiana Health Coverage Programs (IHCP) has expanded Novavax COVID-19 vaccine coverage to include adolescents ages 12-17, effective August 19, 2022. Pharmacies can now bill for Novavax administration to all IHCP members ages 12 and older who haven't completed a primary COVID-19 vaccination series.
Action Required
Immediately: Pharmacies billing IHCP should update their point-of-sale systems to accept Novavax COVID-19 vaccine claims for members ages 12-17. Use specified NCPDP codes: Professional Service Code MA with Service Clarification Code 2 for first dose and 6 for second dose, with $37.21 administration fee. Submit claims to OptumRx for both managed care and fee-for-service members. Contact OptumRx Clinical and Technical Help Desk at 855-577-6317 for pharmacy-related questions.