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Immunization Fee Schedule Updates (IB 24-3)

Date: 01/31/24

Louisiana Healthcare Connections is sharing Immunization Fee Schedule Updates and changes.

Medicaid has updated the following immunization fee schedules on the Louisiana Medicaid website to reflect many recent changes to vaccine and immunization administration procedure codes.

  • Children/Adolescents: (birth through age 18)
  • Young Adult: (ages 19 and 20)
  • Adult: (ages 21 years and older)

The updates below are identified within each applicable fee schedule (both current and previous) for easy identification:

Immunization Changes 

  • 90380 and 90381 – “respiratory syncytial virus (RSV) vaccines,” added effective for date of service (DOS) on and after August 03, 2023.
  • 96372 added for the administration of RSV vaccines 90380 and 90381 through December 31, 2023.
  • 96380 and 96381 were added for the administration of RSV vaccines 90380 and 90381 for dates of service on and after January 1, 2024.
  • 90677 – “pneumococcal conjugate vaccine, 20 valent,” added effective for DOS on and after September 1, 2023.
  • 90678 -TH – “respiratory syncytial virus vaccine,” added for expecting beneficiaries ages 10-99. 
    • Modifier TH identifies this as a prenatal service. 
    • This is not covered under the Vaccines for Children program for recipients age 10-18. 

COVID-19 Vaccine and Administration Codes Added as Covered Services

The following COVID-19 vaccine administration codes were added effective for dates of service on and after April 18, 2023: 

  • Vaccine administration codes: 0121A, 0141A, 0142A, 0151A, 0171A and 0172A. 

The following COVID-19 vaccine and administration codes have been added effective for dates of service on and after September 11, 2023: 

  • Vaccine: 91318, 91319, 91320, 91321 and 91322. 
  • Administration: 90480.

Effective for dates of service on and after October 3, 2023, COVID-19 vaccine 91304 must be submitted with administration code 90480. (Prior to October 3, 2023, the applicable administration codes for 91304 were 0041A, 0042A or 0044A.)

COVID-19 Vaccine and Administration Codes No Longer Authorized

The COVID-19 vaccines and administration procedure codes listed below are no longer authorized for use in the United States: 

  • Effective for dates of service on and after April 18, 2023:
    • Moderna: 0011A, 0012A, 0013A, 0064A, 0091A, 0092A, 0093A, 0094A, 0111A, 0112A, 0113A, 91301, 91306, 91309 and 91311.
    • Pfizer: 0001A, 0002A, 0003A, 0004A, 0051A, 0052A, 0053A, 0054A, 0071A, 0072A, 0073A, 0074A, 0081A, 0082A, 0083A, 91300, 91305, 91307 and 91308. 
  • Effective for dates of service on and after June 1, 2023:
    • Janssen: 0031A, 0034A, and 91303 
  • Effective for dates of service on and after September 12, 2023:
    • Moderna: 0134A, 0141A, 0142A, 0144A, 0164A 91313, 91314 and 91316.
    • Pfizer: 0121A, 0124A, 0151A, 0154A, 0171A, 0172A, 0173A, 0174A, 91312, 91315 and 91317.
  • Effective for dates of service on and after October 3, 2023: 
    • Novavax: 0041A, 0042A and 0044A. 

COVID-19 Novavax Vaccine (91304) Reimbursement Changes

Effective for dates of service on and after October 3, 2023, the fee-on-file for 91304 is $148.20.

If the provider received the Novavax vaccine for free, the billed amount submitted to Medicaid should be $0. Claims with a $0 billed amount will be reimbursed at $0.

If the provider purchased the Novavax vaccine, submit the appropriate billed amount, and reimbursement will be the lower of the billed charges or the fee on file.

Louisiana Healthcare Connections is updating our systems and will automatically recycle claims. Claims previously submitted will be systematically adjusted to ensure proper payment. No action is required by the provider.  

Questions regarding this message and Fee-for-Service claims are to be directed to Gainwell Technologies at (800) 473-2783 or (225) 924-5040.