Frequently Asked Questions
What You Should Know About Coverage Information
The information provided below is not a guarantee of coverage or payment. Providers must follow documentation and billing requirements of payer. Coverage and reimbursement decisions are made by individual plans following receipt of claims from providers. Coverage, reimbursement amount, and administration fee may vary, including by payer, plan, and patient.
Yes, in the 2025-2026 Season Moderna is planning to offer three different COVID-19 vaccine products, pending FDA approval:
- Spikevax® (COVID-19 Vaccine, mRNA) 2025-2026 Formula
- mNEXSPIKE® (COVID-19 Vaccine, mRNA) 2025-2026 Formula
- Moderna COVID-19 Vaccine (2025-2026 Formula)
If approved for the 2025-2026 season, each Moderna vaccine will have its own Current Procedural Terminology (CPT) code and National Drug Code (NDC) used for billing purposes. Moderna has created this “Coding for Reimbursement Excellence” (CORE) tool as a reference for selection of the appropriate codes based on the Moderna vaccine administered for billing purposes.
All 2025-2026 COVID-19 vaccines require FDA approval or authorization prior to sale. Products are available only upon FDA approval or authorization.
Medicare Part B covers FDA-approved COVID-19 vaccines at no cost to patients (no deductible, coinsurance, or copayment) when administered in accordance with the FDA-approved indication by a health care provider that accepts Medicare.
Yes, the American Medical Association (AMA) created a new CPT code to describe mNEXSPIKE:
- CPT code 91323 Severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, 10 mcg/0.2 mL dosage, for intramuscular use
The American Medical Association (AMA) issues CPT codes to describe new immunizations if an existing CPT code does not accurately describe the new vaccine. In the case of mNEXSPIKE, the dosage is different from Spikevax.
mNEXSPIKE has a dosage of 10mcg/0.2mL and uses CPT code 91323.
- CPT code 91323 severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, 10 mcg/0.2 mL dosage, for intramuscular use
Spikevax has a dosage of 50mcg/0.5mL and uses the CPT code 91322.
- CPT code 91322 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, 50 mcg/0.5 mL dosage, for intramuscular use has a dosage of 50mcg/0.5mL.
The Centers for Medicare and Medicaid Services (CMS) lists the codes and payment amounts for COVID-19 vaccines and the related procedures and the information is updated in the July-August timeframe each year. Follow the link COVID-19 Vaccines & Monoclonal Antibodies for the national Medicare fee schedule. For geographically adjusted payment rates for the vaccine administration (CPT 90480) please scroll down below the two charts to the appropriate year’s link for the Locality-Adjusted Payment rates that are updated each calendar year.
Check your state Medicaid fee schedule for payment rates for Medicaid fee for service.
Check your commercial, Medicaid or Medicare Advantage contract for information about payment rates for COVID-19 vaccine administration.
CMS provides information regarding COVID-19 vaccine home administration at this link: Medicare Bill for COVID-19 Vaccine Shot Administration.
CMS provides information regarding mass immunizers and roster billing at the following link: https://www.cms.gov/medicare/payment/covid-19/definitions