On June 27, 2024, the Centers for Disease Control (CDC) Advisory Committee on Immunization Practices (ACIP) recommended 2024–2025 COVID-19 vaccination with an FDA-approved or authorized vaccine for ages 6 months and older. On Aug. 22, 2024, the Food and Drug Administration (FDA), approved new COVID-19 vaccines for the 2024-2025 season, FDA: Covid-19 Vaccines. For details on the 2024-2025 Covid-19 vaccines, visit the CDC’s MMWR: Use of COVID-19 Vaccines for Persons Aged ≥6 Months: Recommendations of the Advisory Committee on Immunization Practices — United States, 2024–2025.
NC Medicaid will cover the COVID-19 2024-2025 vaccines and CPT codes 91318-91322 with an effective date of Aug. 22, 2024.
The Novavax vaccines for the 2024-25 season under CPT code 91304 are covered with an effective date of Aug. 30, 2024.
COVID-19 vaccines are part of the Vaccines for Children program (VFC) (CDC VFC List) for beneficiaries ages 18 and younger. Based on updated Centers for Medicare and Medicaid (CMS) guidance related to the PREP Act, NC Medicaid will cover pharmacy point-of-sale claims for COVID-19 vaccines for beneficiaries ages 3 and older through Dec. 31, 2024. Beginning Jan. 1, 2025, NC Medicaid will only cover COVID-19 vaccines for beneficiaries ages 19 and older in the pharmacy point-of-sale setting.
Read the full NCDHHS bulletin here.
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