Pfizer and Moderna Bivalent COVID-19 Vaccines Authorized to Use as Booster Doses in Children Ages 5 Years and Older
On October 17, 2022, the Office of fb88Care Services (OMS) sent an announcement that we will cover the Pfizer and Moderna bivalent COVID-19 vaccine booster doses as outlined in Emergency Use Authorizations (EUA) from the Food and Drug Administration (FDA).    &²Ô²ú²õ±è;  &²Ô²ú²õ±è;
OMS has completed the update to our systems, and you may begin to submit claims for these services.  &²Ô²ú²õ±è; &²Ô²ú²õ±è;
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Moderna COVID-19 Vaccine Bivalent Booster- Children 12 years and older &²Ô²ú²õ±è; |
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Code &²Ô²ú²õ±è; |
Description &²Ô²ú²õ±è; |
Effective Date &²Ô²ú²õ±è; |
fb88Care Rate &²Ô²ú²õ±è; |
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91313+ &²Ô²ú²õ±è; |
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, bivalent, preservative free, 50 mcg/0.5 mL dosage, for intramuscular use &²Ô²ú²õ±è; |
10/12/22 &²Ô²ú²õ±è; |
$0* &²Ô²ú²õ±è; |
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0134A+ &²Ô²ú²õ±è; |
Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, bivalent, preservative free, 50 mcg/0.5 mL dosage, booster dose &²Ô²ú²õ±è; |
10/12/22 &²Ô²ú²õ±è; |
$36.98 &²Ô²ú²õ±è; |
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Moderna COVID-19 Vaccine Bivalent Booster-6 to 11 years old &²Ô²ú²õ±è; |
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91314 &²Ô²ú²õ±è; |
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, bivalent, preservative free, 25 mcg/0.25 mL dosage, for intramuscular use &²Ô²ú²õ±è; |
10/12/22 &²Ô²ú²õ±è; |
$0* &²Ô²ú²õ±è; |
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0144A &²Ô²ú²õ±è; |
Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRN-LNP, spike protein, bivalent, preservative free, 25 mcg/0.25 mL dosage, booster dose &²Ô²ú²õ±è; |
10/12/22 &²Ô²ú²õ±è; |
$36.98 &²Ô²ú²õ±è; |
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Pfizer BioN-Tech COVID-19 Vaccine Bivalent Booster- 5 to 11 years old  |
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Code &²Ô²ú²õ±è; |
Description &²Ô²ú²õ±è; |
Effective Date &²Ô²ú²õ±è; |
fb88Care Rate &²Ô²ú²õ±è; |
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91315 &²Ô²ú²õ±è; |
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, bivalent spike protein, preservative free, 10 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation, for intramuscular use &²Ô²ú²õ±è; |
10/12/22 &²Ô²ú²õ±è; |
$0* &²Ô²ú²õ±è; |
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0154A &²Ô²ú²õ±è; |
Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, bivalent spike protein, preservative free, 10 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation, booster dose &²Ô²ú²õ±è; |
10/12/22 &²Ô²ú²õ±è; |
$36.98 &²Ô²ú²õ±è; |
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*Government Supplied Vaccines &²Ô²ú²õ±è; +Code previously released 08/31/22 for 18+ &²Ô²ú²õ±è; Note: The COVID-19 vaccine administration codes will be added for  &²Ô²ú²õ±è; |
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 Please be reminded that this authorization replaces the prior EUAs for the Monovalent COVID-19 vaccine booster dose from Pfizer BioN-Tech for individuals ages five and older. &²Ô²ú²õ±è; &²Ô²ú²õ±è;
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No Longer Authorized-Pfizer BioN-Tech COVID-19 Vaccine Booster-5 to 11 years old  |
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°ä´Ç»å±ð  |
Description &²Ô²ú²õ±è; |
Effective Date &²Ô²ú²õ±è; |
End Date &²Ô²ú²õ±è; |
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91307 &²Ô²ú²õ±è; |
Pfizer-BioNTech- Severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 10 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation, for intramuscular use &²Ô²ú²õ±è; |
10/29/21 &²Ô²ú²õ±è; |
10/12/22* &²Ô²ú²õ±è; |
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0074A &²Ô²ú²õ±è; |
Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARSCoV- 2) (coronavirus disease [COVID-19]) vaccine, mRNALNP, spike protein, preservative free, 10 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation; booster dose &²Ô²ú²õ±è; |
05/17/22 &²Ô²ú²õ±è; |
10//12/22 &²Ô²ú²õ±è; |
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*Drug is only authorized for use with a Primary Dose Covid Vaccine Series.  Do not use this drug code when billing booster doses for the age ranges specified.  |
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Providers may visit the fb88 CDC Immunization Program Website for up-to-date information on administering and ordering COVID-19 vaccine and booster doses.    &²Ô²ú²õ±è; &²Ô²ú²õ±è;
If you have questions about the use of Monovalent or Bivalent COVID-19 vaccine booster doses, please contact your Provider Relations Specialist.  &²Ô²ú²õ±è;