MedicaidBilling CodesMedium impact
BT202333: Booster administration of Pfizer COVID-19 bivalent vaccine covered for ages 6 months through 4 years
Indiana Medicaid (IHCP)·IN · Pediatrics, Family Medicine, General Practice·Provider Bulletin
Effective date
Mar 14, 2023
We identified it
Jun 19, 2026
Summary
Indiana Medicaid now covers Pfizer COVID-19 bivalent booster vaccines for children ages 6 months through 4 years, effective March 14, 2023. Providers can bill using new CPT code 0174A for administration paired with vaccine code 91317, with reimbursement at $38.95 maximum fee.
Action Required
Immediately: Billing team must update system to include CPT code 0174A for Pfizer COVID-19 bivalent booster administration for ages 6 months through 4 years. Always bill with vaccine code 91317 and link to revenue code 636. Submit all claims to Gainwell Technologies for FFS processing, regardless of managed care enrollment. Maximum reimbursement is $38.95 per administration.