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 the 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.

Product Group

Yes, in the 2026-2027 Season Moderna offers three different FDA approved COVID-19 vaccine products:

mNEXSPIKE® (COVID-19 Vaccine, mRNA) 2026-2027 Formula 0.2 mL Prefilled Syringe
Spikevax® (COVID-19 Vaccine, mRNA) 2026-2027 Formula 0.5 mL Prefilled Syringe
Spikevax® (COVID-19 Vaccine, mRNA) 2026-2027 Formula 0.25 mL Prefilled Syringe

Each 2026-2027 Moderna COVID-19 vaccine has 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.

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 distinct CPT code to describe mNEXSPIKE:

CPT code 91323: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (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 distinct immunizations if an existing CPT code does not accurately describe the vaccine. In the case of mNEXSPIKE, the dosage is different from Spikevax.mNEXSPIKE has a dosage of 10 mcg/0.2 mL and uses CPT code 91323.

CPT code 91323: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, 10 mcg/0.2 mL dosage, for intramuscular use.

Spikevax 0.5 mL has a dosage of 50 mcg/0.5 mL 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.

Spikevax 0.25 mL has a dosage of 25 mcg/0.25 mL and uses the CPT code 91321.

CPT code 91321: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, 25 mcg/0.25 mL dosage, for intramuscular use.

CMS lists the COVID-19 vaccine and vaccine administration codes, payment allowances, and effective dates on its COVID-19 Vaccines & Monoclonal Antibodies page. The COVID-19 vaccine administration allowance is locality adjusted.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.

More information is available on the CMS Medicare Bill for COVID-19 Vaccine Shot Administration page.

More information is available on the CMS COVID-19 Definitions page.

If you prefer to print out the information to share with your team, you can access the COVID-19 vaccines Billing/Coding Guide here.