KMAP BULLETIN: Novavax COVID-19 Vaccine
Date: 11/17/23
KMAP GENERAL BULLETIN 23289 (PDF)
Effective with dates of service on and after October 3, 2023, Medicaid will cover the updated Novavax COVID-19 Vaccine, Adjuvanted, for ages 12 years and older. Administration codes 0041A, 0042A and 0044A will no longer be covered by Medicaid effective October 3, 2023.
COVID-19 mRNA vaccines are now covered under the Vaccines for Children (VFC) program per recommendation of The Advisory Committee on Immunizations Practices (ACIP) for those 18 years and younger. Reimbursement for vaccines that are covered under the VFC program will not be allowed for persons 18 years and younger.
Administration code for all COVID-19 vaccines is code 90480.
- The administration fee for vaccine provided through the VFC program will be $20.26.
- The administration fee for vaccine provided for those 19 years of age and older will be $14.15.
Novavax COVID-19 Vaccine
Vaccine Code - 91304
Administration Code - 90480
Covered Age - 12 years of age and older
The COVID-19 mRNA vaccines for persons 19 years and older are now commercialized and are not provided free to the state of Kansas.
- 91304 - Novavax Covid-19 Vaccine, Adjuvanted, $130.00
Correct coding guidelines, as well as Food and Drug Administration (FDA) and Centers for Disease Control (CDC) recommendations must be followed.
CDC recommendations can be found here.
Note: The rates noted in this bulletin are subject to future changes. Providers should check the Kansas Medical Assistance Program (KMAP) website for the most up-to-date rates.
Note: The effective date of the policy is October 3, 2023. The implementation of State policy by the KanCare Managed Care Organizations (MCOs) may vary from the date noted in the KMAP bulletins. The KanCare Open Claims Resolution Log on the KMAP Bulletins page documents the MCO system status for policy implementation and any associated reprocessing completion dates once the policy is implemented.