October 5, 2023
New COVID-19 vaccines, labeled 2023-2024 COVID-19 vaccines to differentiate from previous versions and boosters, are now available. COVID-19 vaccines continue to be at no cost for people with health insurance and preventive care benefits. For those without commercial
health insurance, the federal government is providing access through specific providers and pharmacies under the CDC’s Bridge Access Program.
The new vaccines are no longer provided by the government and are being priced commercially by Moderna and Pfizer. The cost of the 2023-2024 COVID-19 vaccine should be billed like you currently bill flu shots or other vaccines to the patient’s health insurer,
using the correct, updated CMS coding. Refer to the updated CMS COVID-19 vaccine pricing website to include codes, descriptors, and pricing information for the recently approved COVID-19 vaccines.
As a reminder, the US Centers for Disease Control and Prevention approved two mRNA vaccines, from Pfizer and Moderna, for those 6 months and older. The updated Novavax vaccine is still under review, but the current formulation of the Novavax COVID-19 vaccine
is still available.
The recommendations include:
- At least one dose of an updated mRNA vaccine against COVID-19 vaccine this year for those ages 5 and up.
- For those 6 months through 4 years, who may be getting their vaccines for the first time, two doses of a Moderna vaccine and three doses of a Pfizer COVID-19 vaccine, with at least one of the doses being an updated 2023 shot are recommended.
- For people who are moderately or severely immunocompromised should have had at least three doses of COVID-19 vaccine, with at least one of those doses being an updated shot. They also have the option to get an additional updated vaccine later in the
year.
Remember to check member’s status through Availity to ensure benefits and eligibility are current.