March 18, 2021

State of Alabama
Press Release: Medicaid

COVID-19 Vaccine Information for Pharmacy Billing

PDF Version 

TO:     All Pharmacy Providers

 

RE:     COVID-19 Vaccine Information for Pharmacy Billing

 

Alabama Medicaid will allow reimbursement to pharmacies for a vaccine administration fee to Medicaid providers who utilize federally allocated COVID-19 vaccines. For claims effective March 15, 2021 and after, the reimbursement rate for the administration fee is $40.00 per dose, and will continue only during that time as described by the American Rescue Plan Act of 2021 that provides for increased FMAP for administration of the COVID-19 Vaccine unless ended sooner by the Alabama Medicaid Agency in a subsequent Alert.


·         Pharmacies will bill vaccines through an electronic NCPDP claim.

o  Submit $0.00 or $0.01 for vaccine provided at no cost from the federal government. 

o  Submit each vaccine with the specific approved vaccine NDC for an eligible recipient.

o  Submit the administration fee in the Incentive Amount Submitted field (NCPDP Field 438-E3) on the same claim as the vaccine (i.e. ingredient).

o  For claims on/after March 15, 2021, the administration fee is $40.00 per dose.

o  Vaccines must be administered according to approved labeling for appropriate ages and dosing interval.

 

      NCPDP Codes and Allowed Amounts for COVID-19 Vaccine Administration

Submission Clarification Code (440-E5)

Incentive Amount (Administration Fee 438-E3)

Ingredient Cost

(409-D9)

Two Dose Vaccines

First Dose

Not needed / blank

$40.00

$0.00 or $0.01

Second Dose

Not needed / blank

$40.00

$0.00 or $0.01

Single-Dose Vaccines

Single Dose

Not needed / blank

$40.00

$0.00 or $0.01

 

    

·   To participate in the administration of COVID-19 vaccine, Alabama providers must enroll in the Alabama Department of Public Health’s (ADPH) ImmPRINT COVID-19 Vaccination Program. Follow the steps in the ImmPRINT Registration Roadmap to enroll.

·        Pharmacies must follow state and federal laws and regulations regarding administration of vaccines.

·      State and federal standing order guidelines for products granted Emergency Use Authorization (EUA) must be followed.  Standing order guidelines can be found at the links below.


oModerna: 

 https://www.alabamapublichealth.gov/immunization/assets/covid19_moderna_standingorders.pdf 


oPfizer/BioNTech: https://www.alabamapublichealth.gov/immunization/assets/covid19_pfizervaccine_standingorders.pdf

 

Pharmacy providers with questions regarding vaccine administration may call the Alabama Medicaid Pharmacy Program at (334) 242-5050.




  • For more information, visit http://medicaid.alabama.gov
  • For more state-wide press releases, click here