MDH ADVISORY No. 252 COVID-19 Vaccine Reimbursement for The Maryland Medicaid Fee-for-Service (FFS) Program.

Maryland Department of Health sent this bulletin at 10/02/2023 08:32 AM EDT

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Hello,

No. 252   October 2, 2023

COVID-19 Vaccine Reimbursement - UPDATE

The Office of Pharmacy Services (OPS) has made modifications to the previously provided
guidance Advisory 219, issued on December 11, 2020, Advisory 221, issued on January 12, 2021,
and Advisory 224, issued on March 23, 2021. Effective September 16, 2023, OPS will be updating
the reimbursement methodology for all FDA/EUA-approved commercialized COVID-19 vaccines
administered by pharmacy providers. Payment for the ingredient cost will follow COMAR
10.09.03.07. The incentive fee will continue to be $40 for the administration of each dose of the
vaccine and the Professional Dispensing Fee will be $0. An updated COVID-19 vaccine payer sheet
is available under Provider Information page at:
https://www.mdhrxprograms.com/webportal/#/publicFacing
The Program’s Point-of-Sale vendor is currently in the process of implementing the necessary
systematic changes for the updated reimbursement methodology, which are projected to be in
place by October 12, 2023.

Until then, all claims for the COVID-19 vaccines will be reimbursed per
COMAR 10.09.03.07 (ingredient cost plus the professional dispensing fee) instead of the
reimbursement stated above. Pharmacy providers who billed for vaccines before the systematic
changes were implemented will have to reverse and rebill the original claim to receive correct
reimbursement (ingredient cost plus the administration fee).

Thank you for your cooperation in advance. If you have any questions, please send an email to MDH.mmpp@maryland.gov

See attachment for details.