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The Centers for Medicare & Medicaid Services (CMS) wanted to provide you with the latest update on recent actions by the U.S. Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention’s (CDC) Advisory Committee on Immunization Practices (ACIP) regarding additional doses of COVID-19 vaccines following an initial 2-dose primary series of mRNA COVID-19 vaccine for certain immunocompromised individuals.
On August 12, 2021, the FDA amended the emergency use authorizations (EUAs) for both the Pfizer-BioNTech COVID-19 Vaccine and the Moderna COVID-19 Vaccine to allow for the use of an additional dose in certain immunocompromised individuals, specifically, solid organ transplant recipients or those who are diagnosed with conditions that are considered to have an equivalent level of immunocompromise. FDA’s action does not apply to people who are not immunocompromised. Learn more here: https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-authorizes-additional-vaccine-dose-certain-immunocompromised
Additionally, on August 13, 2021 the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP) also unanimously recommended a third dose of mRNA (Pfizer-BioNTech or Moderna) COVID-19 vaccine after an initial 2-dose primary series of mRNA COVID-19 vaccine for immunocompromised individuals. Learn more here: https://www.cdc.gov/vaccines/covid-19/clinical-considerations/covid-19-vaccines-us.html
The CMS Center for Medicare has announced that the Medicare program will be using Current Procedural Terminology (CPT) code 003A for the Pfizer vaccine and 0013A for the Moderna vaccine. More information can be found here. States should ensure that their Medicaid and CHIP providers use these standard procedure codes for COVID-19 vaccination claims and encounters.
State Medicaid and Children’s Health Insurance Program (CHIP) agencies must cover COVID-19 vaccine administration with no cost sharing for nearly all enrollees during the COVID-19 public health emergency (PHE) and (generally) for over a year after it ends. This coverage would also include the administration of an additional vaccine dose for those who are immunocompromised. In addition, the American Rescue Plan Act of 2021 (ARP) provides for a temporary 100% federal medical assistance percentage (FMAP) and CHIP enhanced FMAP for amounts expended by a state for medical assistance for COVID-19 vaccines and their administration. Please refer to the Coverage and Reimbursement of COVID-19 Vaccines, Vaccine Administration, and Cost Sharing under Medicaid, the Children’s Health Insurance Program, and Basic Health Program toolkit for more information: https://www.medicaid.gov/state-resource-center/downloads/covid-19-vaccine-toolkit.pdf
The Center for Medicaid & CHIP Services (CMCS) is available to provide technical assistance to states and is ready to review and process any state plan amendments needed to implement payment policies for a third dose of a COVID-19 vaccine. We will also continue to monitor COVID-19 vaccination recommendations and will provide further updates as they are available.
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