Provider Coronavirus Information

Answering Patient Questions about the Vaccine

Your patients will likely have a lot of questions about the vaccine, and as their healthcare provider, they will turn to you for answers.

Peach State Health Plan is closely following advancements in the prevention and treatment of COVID-19, including vaccinations. As a healthcare provider, you will play an integral role as COVID-19 vaccines become available. We want to update you on important new information about vaccine coverage.  

To prepare for vaccine administration, the Centers for Medicare and Medicaid (CMS) have begun to publish guidance for Medicaid and Children’s Health Insurance Program (CHIP) providers. Similar to other COVID-19 services, the vaccines will be offered at no cost to your patients. In addition:

  • Peach State Health Plan will configure its systems to properly adjudicate COVID-19 vaccine-related claims in accordance with Georgia’s coverage determinations for Medicaid beneficiaries
  • Member liability will be $0
  • The Pfizer Vaccine is approved for members 16 and older
  • The Moderna Vaccine is approved for members 18 and older
  • Non-participating provider pre-authorization requirements will be waived
  • Members enrolled in Planning for Healthy Babies receiving Family Planning benefits only are excluded. Providers should contact HRSA Provider Relief Fund (Uninsured individuals and Limited Benefit Plans) for reimbursement for vaccines administration.

The American Medical Association (AMA) has published updates tto the Current Procedural Terminology (CPT®) code set that includes new vaccine-specific codes to report immunizations for the novel coronavirus (SARS-CoV-2).

In addition, effective December 17, 2020, DCH will begin reimbursing pharmacy providers through the Pharmacy Point of Sale System for the administration of COVID-19 vaccines for GA Medicaid Fee-for-Service (FFS) members. 

Code

CPT Short Descriptor

Labeler Name

Vaccine/Procedure Name

Reimbursement Admin. Fee

91300

SARSCOV2 VAC

30MCG/0.3ML IM

Pfizer

Pfizer-BioNtech Covid-19 Vaccine

 

0001A

ADM SARSCOV2 VAC

30MCG/0.3ML 1ST

Pfizer

Pfizer-BioNtech Covid-19 Vaccine

Administration – First Dose

$10

0002A

ADM SARSCOV2 VAC

30MCG/0.3ML 2ND

Pfizer

Pfizer-BioNtech Covid-19 Vaccine

Administration – Second Dose

$10

91301

SARSCOV2 VAC

100MCG/0.5ML IM

Moderna

Moderna Covid-19 Vaccine

 

0011A

ADM SARSCOV2 VAC

100MCG/0.5ML 1ST

Moderna

Moderna Covid-19 Vaccine

Administration – First Dose

$10

0012A

ADM SARSCOV2 VAC

100MCG/0.5ML 2ND

Moderna

Moderna Covid-19 Vaccine

Administration – Second Dose

$10

Additionally, CMS has also published a set of toolkits to help providers prepare to swiftly administer the vaccine once it is available. If you have any further questions about this upcoming vaccine or the COVID-19 services Peach State Health Plan covers, please contact Provider Services at 866-874-0633.