Coding for Reimbursement

Medicaid

How are you billing?

Medicaid pharmacies billing with the NCPDP format should use the appropriate NDC and units for the vaccine administered.

Check with you state Medicaid agency or Medicaid managed care entity for specific coverage and billing requirements unique to your state.

Based on your inputs:
  1. mNEXSPIKE
  2. Medicaid
  3. Pharmacy benefit
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NDC Codes

mNEXSPIKE (COVID-19 Vaccine, mRNA 10mcg/0.2mL)

SINGLE DOSE PREFILLED SYRINGE:
80777-400-17

NOTES:

The Billing Unit (BU) is a milliter (mL) for the individual vaccine product with the quantity of the number of units dispensed.

  • mNEXSPIKE (COVID-19 Vaccine, mRNA) for individuals 12 years of age and older is billed with 0.2mL).

Remember to bill for the administration service if performed.

For more details, visit our Frequently Asked Questions page.

Please see the mNEXSPIKE® Full Prescribing Information.

mNEXSPIKE® Full Prescribing Information

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 the provider's responsibility and should always be based on the patient's clinical condition, services provided, and current payer guidelines.