Coding for Reimbursement

Medicaid

For commercially acquired product, (not vaccine for children product), Medicaid health care providers should code for the vaccine product administered and the related COVID-19 vaccine administration.

Check with your state agency or Medicaid managed care entity to determine any specific coverage or coding requirements.

Based on your inputs:
  1. Moderna COVID-19 Vaccine (6 months - 11 years)
  2. Medicaid
  3. Medical benefit
Start Over

CPT Code - Vaccine Product

Use the CPT code for the vaccine and dose administered.

Moderna COVID-19 Vaccine 2024-2025 Formula 25mcg/.25mL (6mos-11 years)

VACCINE CODE:
CPT 91321
VACCINE DESCRIPTOR:

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, 25mcg/0.25mL dosage, for intramuscular use.

CPT Code - Administration

Use CPT code 90480 for administration of all COVID-19 vaccinations.
ADMINISTRATION CODE:
CPT 90480
ADMINISTRATION DESCRIPTOR:

Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-
2) (coronavirus disease [COVID-19]) vaccine, single dose.

Additional Codes

ICD-10

DIAGNOSIS CODE:
Z23 Encounter for Immunization
DIAGNOSIS DOCUMENTATION:

Document the patient's situation and use consistent with the FDA authorization and CDC guidelines as appropriate.

CVX

CVX CODE:
311
CVX DESCRIPTOR:
  • SARS-COV-2 (COVID-19) vaccine, mRNA, spike protein, LNP, preservative free, 25 mcg/0.25 mL dose
  • Used for registries as required.

For more details, visit our Frequently Asked Questions page.

Please see the Spikevax® 2024-2025 Formula Prescribing Information and the Moderna COVID-19 Vaccine (2024-2025 Formula) Fact Sheets for more information.

Spikevax 2024-2025 Formula Prescribing Information 12y

Moderna COVID-19 Vaccine 2024-2025 Formula Fact Sheet for Vaccine Providers 6m-11y

Moderna COVID-19 Vaccine 2024-2025 Formula Fact Sheet for Vaccine Recipients 6m-11y

The coding and billing information contained in this digital tool is provided as a resource and every effort is made to ensure the accuracy of this information. Appropriate coding and billing for healthcare services are theprovider's responsibility and should always be based on the patient's clinical condition, services provided, and current payer guidelines