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The Centers for Medicare & Medicaid
Services (CMS) wanted to provide you with the latest update on recent
actions by the U.S. Food and Drug Administration (FDA) and the Centers for
Disease Control and Prevention’s (CDC) Advisory Committee on Immunization Practices (ACIP) regarding additional doses of
COVID-19 vaccines following an initial 2-dose primary series of mRNA
COVID-19 vaccine for certain immunocompromised individuals.
On August 12, 2021, the FDA amended
the emergency use authorizations (EUAs) for both the Pfizer-BioNTech
COVID-19 Vaccine and the Moderna COVID-19 Vaccine to allow for the use of
an additional dose in certain immunocompromised individuals, specifically,
solid organ transplant recipients or those who are diagnosed with
conditions that are considered to have an equivalent level of
immunocompromise. FDA’s action does not apply to people who are not
immunocompromised.
Learn more here: https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-authorizes-additional-vaccine-dose-certain-immunocompromised
Additionally, on August 13, 2021 the
Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP) also unanimously recommended a third
dose of mRNA (Pfizer-BioNTech or Moderna) COVID-19 vaccine after an initial
2-dose primary series of mRNA COVID-19 vaccine for immunocompromised
individuals. Learn more here: https://www.cdc.gov/vaccines/covid-19/clinical-considerations/covid-19-vaccines-us.html
The CMS Center for Medicare has
announced that the Medicare program will be using Current Procedural Terminology (CPT) code 003A for the Pfizer vaccine and 0013A
for the Moderna vaccine. More information can be found here. States should ensure that their
Medicaid and CHIP providers use these standard procedure codes for COVID-19
vaccination claims and encounters.
State Medicaid and Children’s Health
Insurance Program (CHIP) agencies must cover COVID-19 vaccine
administration with no cost sharing for nearly all enrollees during the
COVID-19 public health emergency (PHE) and (generally) for over a year
after it ends. This coverage would also include the administration of
an additional vaccine dose for those who are immunocompromised. In
addition, the American Rescue Plan Act of 2021 (ARP) provides for a
temporary 100% federal medical assistance percentage (FMAP) and CHIP
enhanced FMAP for amounts expended by a state for medical assistance for
COVID-19 vaccines and their administration. Please refer to the
Coverage and Reimbursement of COVID-19 Vaccines, Vaccine Administration,
and Cost Sharing under Medicaid, the Children’s Health Insurance Program,
and Basic Health Program toolkit for more information: https://www.medicaid.gov/state-resource-center/downloads/covid-19-vaccine-toolkit.pdf
The Center for Medicaid & CHIP
Services (CMCS) is available to provide technical assistance to states and
is ready to review and process any state plan amendments needed to
implement payment policies for a third dose of a COVID-19 vaccine. We
will also continue to monitor COVID-19 vaccination recommendations and will
provide further updates as they are available.
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