August 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 Agency in a subsequent ALERT. A booster dose will be allowed.


•    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    Medicaid will allow for vaccine/administration with an effective date on/after December 28, 2020.
           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.
         o   Effective August 13, 2021, providers may submit claims for a booster dose of mRNA vaccines in moderately to severely immunocompromised patients. Please refer to the CDC guidance for third dose here:  https://www.cdc.gov/coronavirus/2019-ncov/vaccines/recommendations/immuno.html
                                     
o   Booster doses of mRNA vaccines should be administered at least 28 days after the second dose.
                                 
      o   Claims for booster doses should be submitted with a Submission Clarification Code (SCC) (NCPDP Field 420-DK) of 07.
                                
o   By entering a SCC of 07, the provider is attesting that the patient meets the requirement of being moderately to severely immunocompromised.

•    Per the Public Readiness and Emergency Preparedness (PREP) Act, either the Pharmacy or the Pharmacist NPI may be submitted on claims for COVID-19 vaccines only. 
           o    Claims for administration of COVID-19 vaccines with the Pharmacy or Pharmacist NPI submitted in the prescriber field should be submitted with a SCC of 42 indicating that the prescriber ID submitted is valid and prescribing requirements have been validated.


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

blank

$40.00

$0.00 or $0.01

Second Dose

blank

$40.00

$0.00 or $0.01

Booster Dose

07

$40.00

$0.00 or $0.01

Single-Dose Vaccines




Single Dose

blank

$40.00

$0.00 or $0.01


•    The payment rate for COVID-19 vaccine administration is $40.00 to administer any dose of the vaccine. As of March 15, 2021, the Submission Clarification Code indicating the first and second dose is being administered is no longer required. A SCC of 07 should be included on booster doses.

•    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.
          o    Moderna:
Moderna COVID-19 Vaccine: Standing Orders for Administering Vaccine to Persons 18 Years of Age and Older (cdc.gov)
          o    Pfizer/BioNTech:
Pfizer-BioNTech COVID-19 Vaccine Standing Orders for Administering Vaccine (cdc.gov)
          o    Janssen:
Janssen COVID-19 Vaccine (Johnson & Johnson): Standing Orders for Administering Vaccine to Persons 18 Years of Age and Older (cdc.gov)

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



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