Blue Cross and Blue Shield of North Carolina (Blue Cross NC) remains committed to ensuring members have access to COVID-19 vaccines as part of their preventive care.

What’s Covered

• COVID-19 vaccine coverage has not changed.
• Members can continue to receive the COVID-19 vaccine and booster at no out-of-pocket cost when billed as preventive and administered by in-network providers.
• Coverage applies whether the vaccine is administered in a primary care setting or pharmacy.

Eligibility Guidance

• As of October 6, the Centers for Disease Control and Prevention (CDC), Advisory Committee on Immunization Practices (ACIP), and the U.S. Food and Drug Administration (FDA) have approved updated COVID-19 vaccines for the 2025 - 2026 season.
• Under the new approvals, COVID-19 boosters are recommended for anyone older than six months who has determined, with their provider, that they should receive the vaccine.
• Providers, including doctors, nurses, and pharmacists, should guide members based on clinical judgment and evolving federal recommendations.

Provider Responsibilities

• Follow clinical guidelines from ACIP, the American Academy of Pediatrics (AAP), the American Medical Association (AMA), the American College of Obstetricians and Gynecologists (ACOG) and other leading medical organizations when administering vaccines.
• Use correct coding:
  • Administration code: 90480 – Immunization administration by intramuscular injection of SARS-CoV-2 vaccine, single dose.
  • For full coding details, refer to the AMA COVID-19 CPT codes.
• Reimbursement:
  • Commercial plans: Rates align with Blue Cross NC’s April 1, 2025 fee schedule.
  • Medicare Advantage: Reimbursed at $45 per dose under CMS Part B.

Pharmacy Administration

ACIP classifies pharmacists as a provider that can administer the vaccine under a shared clinical decision-making framework. Members do not need a prescription from a primary care provider to receive the vaccine at a retail pharmacy. Pharmacists must follow the laws of the state in which they practice when administering all vaccines.

What Providers Should Do

• Educate patients on vaccine availability and importance.
• Encourage vaccination for members who have a high risk of adverse health outcomes associated with COVID-19 infection or would like to reduce their risk from exposure to the virus.
• Direct members to the Blue Cross NC Preventive Care page for updates.