Effective July 1, 2020
When administered by a pharmacist, vaccines and vaccine administration are covered for members enrolled in Montana Healthcare Programs who are 19 years of age and older. The vaccine administration fee for the first vaccine is $21.32 and is $14.34 for each additional vaccine.
Please Note: The vaccine administration fee is in lieu of the standard pharmacy dispensing fee. Pharmacies should not bill for a dispensing fee.
The following NCPDP fields are required for Medicaid to properly reimburse for the vaccine and the administration fee:
- 439-E4 (Reason for Service Code) – Submit AD (Additional Drug Needed);
- 438-E3 (Incentive Amount Submitted) – For submitting your usual and customary vaccine
administration fee; and - 440-E5 (DUR Professional Service Code) – Submit MA (Medication Administration).
Be careful to submit the correct vaccine unit, which is often less than 1.0.