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BT2021100: IHCP to cover Covid-19 vaccine booster shots
Act
immediately
Effective date
Oct 20, 2021
Identified
Jun 19, 2026
Summary
Indiana Health Coverage Programs (IHCP) will now cover COVID-19 vaccine booster shots effective immediately, with specific billing codes for Pfizer, Moderna, and Johnson & Johnson boosters. The policy provides reimbursement rates of $37.21 for administration codes and establishes eligibility criteria for different age groups and risk categories.
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What to do
immediately · 4 steps
01Billing team must update system to bill new COVID-19 booster administration codes (0004A for Pfizer, 0034A for Johnson & Johnson, 0064A for Moderna) at $37.21 reimbursement rate.
02Submit professional claims to Gainwell Technologies and pharmacy claims to OptumRx.
03Verify patient eligibility meets CDC/FDA criteria before administration.
04Update encounter forms with new codes and age/risk requirements.
Codes mentioned
91306
Original notice
BT2021100: IHCP to cover Covid-19 vaccine booster shots
in.gov · Always check the source before changing claims.
Related changes
See all Indiana Medicaid (IHCP) changes →BT202361: IHCP removes coverage for Pfizer and Moderna monovalent COVID-19 vaccine codesMediumEffective Apr 18, 2023 · Medical PolicyBT2020129: IHCP receives COVID-19 vaccine HCPCS update from CMS and AMAMediumEffective Dec 11, 2020 · Claims & BillingBT202126: Additional codes covered for COVID-19 vaccine and treatmentMediumEffective Feb 9, 2021 · Provider BulletinBT202172: IHCP to reimburse administration for third dose of specified COVID-19 vaccinesMediumEffective Aug 12, 2021 · Provider BulletinBrowse every Indiana Medicaid (IHCP) change in the policy list