COVID-19 Vaccine Reimbursement Information for Georgia Medicaid Providers

The Pfizer BioNTech COVID-19 Vaccine and the Moderna COVID-19 Vaccine have been approved by the Food and Drug Administration (FDA) and the Advisory Committee on Immunization Practices (ACIP) for emergency use and may be administered to Medicaid and CHIP members ages 16 and older by qualified providers.  The current reimbursement rate for the administration of the vaccine is $10 per dose. The appropriate codes, descriptions, and reimbursement rates are listed in the chart below.

The vaccine is to be administered to Medicaid and CHIP beneficiaries free of charge.  Thus, Medicaid and CHIP beneficiaries may not be charged or billed for receipt of the vaccine.  Further, Medicaid and CHIP beneficiaries are not required to pay any copayments related to receipt of the vaccine.

Providers must administer the vaccine in accordance with the Centers for Disease Control (CDC) and ACIP requirements and must meet storage and record keeping requirements. We recommend providers and pharmacies utilize their internal systems to ensure Medicaid and CHIP beneficiaries receive notice and reminders regarding vaccinations.

Providers are strongly encouraged to review the Georgia COVID-19 Vaccination Plan as recently outlined by the Georgia Department of Public Health (DPH).  The Georgia COVID-19 Vaccination Plan may be accessed on the Georgia Department of Public Health’s website at https://dph.georgia.gov/covid-vaccine.  

In addition, effective December 17, 2020, DCH will begin reimbursing pharmacy providers through the Pharmacy Point of Sale System for the administration of COVID-19 vaccines for GA Medicaid Fee-for-Service (FFS) members.  For more information, please visit the Georgia Medicaid web portal at www.mmis.georgia.gov.  Once there, click on pharmacy/pharmacy notices.

Please stay tuned for additional updates.  Should you have additional questions or concerns, please contact the Gainwell Technologies Call Center at 770-325-9600 or 1-800-766-4456 or contact us at www.mmis.georgia.gov.

Thank you for your continued participation in the Georgia Medicaid program.