Roster Billing Solution for COVID-19 and Influenza Vaccinations, CR 84143 and CR 105379
Maine Department of Health & Human Services sent this bulletin at 11/23/2021 01:11 PM EST
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Roster Billing Solution for COVID-19 and Influenza Vaccinations, CR 84143 and CR 105379
MaineCare is introducing a new roster billing method to submit COVID-19 and influenza vaccination claims on the Health PAS Online Portal.
Effective November 22, 2021, providers can submit vaccine and vaccine administration services for the set of codes listed below using a roster billing excel spreadsheet template instead of submitting individual claims. Providers can submit the spreadsheet, and the system will process the file and generate either an 837I or 837P claims file similar in functionality to the Electronic Data Interchange (EDI) method.
Please refer to the Roster Billing Specification document for more detailed information.
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Roster Billing COVID-19 and Influenza Vaccine Administration Codes |
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Code |
Description |
Effective Date |
Vaccine Type |
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0001A |
Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3mL dosage, diluent reconstituted; first dose |
12/11/2020 |
Pfizer-BioNTech COVID-19 First Dose |
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0002A |
Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3mL dosage, diluent reconstituted; second dose |
12/11/2020 |
Pfizer-BioNTech COVID-19 Second Dose |
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0003A |
Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3 mL dosage, diluent reconstituted; third dose |
08/12/2021 |
Pfizer-BioNTech COVID-19 Third Dose |
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0004A |
Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3 mL dosage, diluent reconstituted; booster dose |
09/22/2021 |
Pfizer-BioNTech COVID-19: Booster Dose |
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0071A |
Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 10 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation; first dose |
10/29/2021 |
Pfizer-BioNTech COVID-19: Pediatric First Dose |
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0072A |
Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 10 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation; second dose |
10/29/2021 |
Pfizer-BioNTech COVID-19: Pediatric Second Dose |
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0011A |
Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 100 mcg/0.5mL dosage; first dose |
12/18/2020 |
Moderna COVID-19 First Dose |
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0012A |
Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 100 mcg/0.5mL dosage; second dose |
12/18/2020 |
Moderna COVID-19 Second Dose |
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0013A |
Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 100 mcg/0.5 mL dosage; third dose |
08/12/2021 |
Moderna COVID-19 Third Dose |
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0064A |
Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 50 mcg/0.25 mL dosage, booster dose |
10/20/2021 |
Moderna COVID-19 Low-dose Booster |
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0031A |
Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (coronavirus disease [COVID-19]) vaccine, DNA, spike protein, adenovirus type 26 (Ad26) vector, preservative free, 5x1010 viral particles/0.5mL dosage, single dose |
02/27/2021 (Pause in coverage from 4/12/2021 to 4/22/2021) |
Janssen (J&J) COVID-19 Single Dose |
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0034A |
Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, DNA, spike protein, adenovirus type 26 (Ad26) vector, preservative free, 5x1010 viral particles/0.5 mL dosage; booster dose |
10/20/2021 |
Janssen (J&J) COVID-19 Booster Dose |
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90460 |
Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; first or only component of each vaccine or toxoid administered |
N/A |
For use in roster billing for influenza immunization administration |
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90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 vaccine (single or combination vaccine/toxoid) |
N/A |
For use in roster billing for influenza immunization administration |
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90473 |
Immunization administration by intranasal or oral route; 1 vaccine (single or combination vaccine/toxoid) |
N/A |
For use in roster billing for influenza immunization administration |
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G0008 |
MaineCare influenza vaccine for IHS, RHC, FQHC, School Health Centers Provider Claims |
N/A |
For use in roster billing for influenza immunization administration |
More information is available by calling Provider Services at 1-866-690-5585, Option 3. TTY users dial 711.