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COVID-19 Vaccine Administration - Updated Information Based on DHS Changes (April 23)

As promised in previous communications, we continue to monitor and update pricing related to COVID-19 vaccine administration. In response to a recent Pennsylvania Department of Human Services (DHS) Medical Assistance Bulletin released on April 19, 2021, we have increased our reimbursement for COVID-19 vaccine administration to align with that bulletin. The new rates are reflected in the table below. The cost of these vaccine serums will be paid for by the U.S. government.

HPP will continue to follow both the Centers for Medicaid & Medicare Services (CMS) and the Pennsylvania Department of Human Services (DHS) policies related to coding and reimbursement.

It is important to note that the reimbursement detailed in this communication is applicable to all provider types and places of service.

Note for Urgent Care Centers - Vaccine administration should not be billed as an urgent care visit. Urgent Care Centers will require a contract amendment for the vaccine administration codes and will receive additional communication.

Medicaid Medicare CHIP Non-Par Providers
Medicaid & CHIP
$40.00*
(1st Dose)

$40.00*
(2nd Dose)
$0
Provider is required
to bill CMS
$40.00*
(1st Dose)

$40.00*
(2nd Dose)
$40.00*
(1st Dose)

$40.00*
(2nd Dose)

*May be updated by DHS

We appreciate your continued support in managing the needs of our members. If you have any questions, please contact our Provider Services Helpline at 1-888-991-9023, Monday – Friday, 9 a.m. – 5:30 p.m.

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