COVID-19 Reimbursement Vaccine Codes

Updated 07.14.22

Blue Cross Blue Shield of Wyoming welcomes the arrival of safe and effective vaccines as a key component in the national and local COVID-19 response. BCBSWY will waive all cost-sharing for any fees charged to administer the vaccines. 

Each vaccine has its own code and administration code. Since the Pfizer and Moderna vaccines require two doses, each vaccine has two administration codes to indicate which dose was administered. Please see the table below for coding guidance including the Johnson & Johnson vaccine.                                                                       

Manufacturer  Vaccine Code  Description  Administration Codes 
Pfizer 91300 Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3mL dosage, diluent reconstituted, for intramuscular use
  • 0001A (1st dose)
  • 0002A (2nd dose)
  • 0003A (3rd dose)
  • 0004A (booster)

 

 

Pfizer 91308 Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 3 mcg/0.2mL dosage, diluent reconstitued, tri-sucrose formulation, for intramuscular use
  • 0081A (1st dose)
  • 0082A (2nd Dose)
  • 0083A (3rd Dose)
Pfizer (Pediatric) 91307 Severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (coronavirus disease [COVID-19]) vaccine, mRNALNP, spike protein, preservative free, 10 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation, for intramuscular use
  • 0071A (1st Dose)
  • 0072A(2nd Dose)
Moderna 91301 Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 100 mcg/0.5mL dosage, for intramuscular use

 

  • 0011A (1st dose)
  • 0012A (2nd dose)
  • 0013A (3rd dose)
Moderna 91311 Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 25 mcg/0.25 mL dosage
  • 0111A (1st Dose)
  • 0112A (2nd Dose)
  • 0113A (3rd Dose)
Moderna (Booster) 91309 IMMUNIZATION ADMINISTRATION BY INTRAMUSCULAR INJECTION OF SEVERE ACUTE RESPIRATORY SYNDROME CORONAVIRUS 2 (SARSCOV-2) (CORONAVIRUS DISEASE [COVID-19]) VACCINE, MRNA-LNP, SPIKE PROTEIN, PRESERVATIVE FREE, 50 MCG/0.5 ML DOSAGE, BOOSTER DOSE when administered to individuals 18 years and over 0094A
Moderna (Booster) 91306 Severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (coronavirus disease [COVID-19]) vaccine, mRNALNP, spike protein, preservative free, 50 mcg/0.25 mL dosage, for intramuscular use 0064A
Moderna (Pediatric) 91309 Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 50 mcg/0.5 mL dosage; when administered to individuals 6 through 11 years
  • 0091A (1st Dose)
  • 0092A (2nd Dose)
  • 0093A (3rd Dose)
Janssen/Johnson& Johnson 91303 Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, DNA, spike protein, adenovirus type 26 (Ad26) vector, preservative free, 5×1010 viral particles/0.5mL dosage, for intramuscular use
  • 0031A (single dose)

 

Inpatient Hospital Prior Authorizations & Concurrent Review Update 

Beginning April 1st, 2021 all hospital inpatient prior authorizations and concurrent reviews for BCBSWY members should be submitted through the Availity portal. To assist our providers with this transition, BCBSWY will be offering two training sessions this March. To register please contact Provider Relations at provider.relations@bcbswy.com. If you are unable to attend any of these trainings let us know and we can set up an individual session. For more information on prior authorization requirements please visit: https://www.bcbswy.com/providers/preadmin/.

Training Schedule: 

March 16th, 2:00 pm

March 18th, 2:00 pm

 

Is your practice offering telemedicine?  

BCBSWY would like to know if your practice offers telemedicine visits to your patients. If so, please complete this short form.  We will use this information to update the BCBSWY Provider Directory to let patients know you offer this service. 

 

EFT Requests 

Reminder, you can enroll or make changes to an EFT account through Availity. View this training guide for questions. 

 

BCBSWY Mailing Address:

PO Box 2266, Cheyenne, WY 82003-2266

Blue Cross Blue Shield of Wyoming is an independent licensee of the Blue Cross and Blue Shield Association

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