COVID-19 Vaccine Product and Administration Code Additions  

COVID-19 Vaccine Product and Administration Code Additions  

This message contains important information regarding MaineCare’s coverage of the COVID-19 vaccine administration and product, reimbursement rates, covered populations, and more.    

Please note that a provider administering a COVID-19 vaccine to a MaineCare member must be enrolled with the Maine CDC to administer the vaccine and must comply with all CDC requirements with respect to record-keeping, vaccine handling, and vaccine administration. 

Update for Section 5, 14, 45, and 90 Providers:   

Starting December 30, 2020, providers of services in the following sections of MaineCare policy may submit claims for COVID-19 vaccination administration and product:    

Effective dates and reimbursement rates are outlined in the table below. 

*Ambulance Services:  

Emergency medical providers who are enrolled with the CDC to administer COVID-19 vaccines and who are enrolled with MaineCare to provide Ambulance services may bill for the administration of the COVID-19 vaccine at the same reimbursement levels outlined above. For vaccination administration billing, please use the diagnosis code Z23 (encounter for immunization).   

Planned Update for Section 80, Pharmacy Services Providers:  

The Department plans to update the Maine Pharmacy Point of Purchase System (MEPOPS) to also allow pharmacies to bill for the administration of the COVID-19 vaccine at the same reimbursement levels outlined above. We will notify you when this change has been made and will provide further billing guidance at that time.  

Planned Updates for Section 3, 9, 31, 40, and 103 Providers: 

The Department plans to update MIHMS to add vaccination administration and product codes as covered services under the following sections of MaineCare policy, as well:  

We will notify you when this change has been made and will provide further billing guidance at that time.  

Covered Populations: 

The COVID-19 vaccine is a covered benefit for all full MaineCare members, for members who are covered through MaineCare’s Special Benefits Waiver, and for members who are in the pregnancy presumptive eligibility category (also known as “pregnancy-related coverage”). The vaccine is available to these members at no cost to them.  

Non-Covered Populations: 

Providers who administer a licensed or authorized COVID-19 vaccine to uninsured individuals or those enrolled in MaineCare with certain limited benefits (family planning services, family planning presumptive eligibility, emergency MaineCare, and prisoner inpatient) can request reimbursement through the federal Health Resources & Services Administration (HRSA). For more information on the process and the availability of funds, please visit HRSA’s website. For more guidance about vaccine coverage for uninsured individuals or those with limited benefits, please see CMS’ website.   

Provider Enrollment: 

Providers who intend to administer the COVID-19 vaccine must ensure that, in addition to being enrolled with MaineCare, they complete and receive approval through the required Maine CDC COVID-19 vaccine provider enrollment process. Please see our November 5, 2020 e-message on this topic for more information. Providers may also visit the Maine CDC’s COVID-19 Vaccine Provider Portal website for additional information.   

Providers who administer a COVID-19 vaccine to a MaineCare member shall bill in accordance with the requirements of the section of the MaineCare Benefits Manual under which the provider is enrolled and shall comply with all other requirements under their section.   

Additional Information: 

Please note that we will notify providers if MaineCare is able to accommodate roster billing at a future date.  

Providers and the public are also encouraged to visit the Office of the Governor’s COVID-19 vaccine webpage for information. 

Please contact your Provider Relations Specialist with questions.