Products billed under this code include COMIRNATY 2024-2025 Preservative Free, COMIRNATY 2025-2026 AGE OVER 65 / HIGH RISK 12-64Y, 30 MCG/0.3 ML vial.
Payment limit per 0.3 ML, by effective quarter, 4Q23 to 4Q26. Gaps mean the code was not in that quarter’s file, or CMS gave no payment limit.From the 4Q26 NDC–HCPCS crosswalk. “Limit / pkg” is the 4Q26 payment limit times the billing units in one package.
| Product | Labeler | NDC | Units / pkg | Limit / pkg |
|---|---|---|---|---|
| COMIRNATY 2024-2025 Preservative Free | Pfizer | 00069-2403-10 | 10 | $2,304.05 |
| COMIRNATY 2025-2026 AGE OVER 65 / HIGH RISK 12-64Y, 30 MCG/0.3 ML vial | Pfizer | 00069-2528-10 | 10 | $2,304.05 |
| Quarter | Payment limit | Change | Billing unit | Description | Source file |
|---|---|---|---|---|---|
| 4Q26 | $230.405 | +$62.038 | 0.3 ML | SARSCV2 VAC 30MCG TRS-SUC IM | v1, posted September 17, 2026 |
| 3Q26 | $168.367 | $0.00 | 0.3 ML | SARSCV2 VAC 30MCG TRS-SUC IM | v1, posted September 15, 2026 |
| 2Q26 | $168.367 | $0.00 | 0.3 ML | SARSCV2 VAC 30MCG TRS-SUC IM | v1, posted September 15, 2026 |
| 1Q26 | $168.367 | $0.00 | 0.3 ML | SARSCV2 VAC 30MCG TRS-SUC IM | v1, posted September 15, 2026 |
| 4Q25 | $168.367 | +$12.472 | 0.3 ML | SARSCV2 VAC 30MCG TRS-SUC IM | v1, posted September 8, 2026 |
| 3Q25 | $155.895 | $0.00 | 0.3 ML | SARSCV2 VAC 30MCG TRS-SUC IM | v1, posted March 10, 2026 |
| 2Q25 | $155.895 | $0.00 | 0.3 ML | SARSCV2 VAC 30MCG TRS-SUC IM | v1, posted March 10, 2026 |
| 1Q25 | $155.895 | $0.00 | 0.3 ML | SARSCV2 VAC 30MCG TRS-SUC IM | v1, posted December 19, 2025 |
| 4Q24 | $155.895 | +$24.795 | 0.3 ML | SARSCV2 VAC 30MCG TRS-SUC IM | v1, posted June 11, 2025 |
| 3Q24 | $131.10 | $0.00 | 0.3 ML | SARSCV2 VAC 30MCG TRS-SUC IM | v1, posted June 11, 2025 |
| 2Q24 | $131.10 | $0.00 | 0.3 ML | SARSCV2 VAC 30MCG TRS-SUC IM | v1, posted March 11, 2025 |
| 1Q24 | $131.10 | $0.00 | 0.3 ML | SARSCV2 VAC 30MCG TRS-SUC IM | v1, posted December 19, 2024 |
| 4Q23 | $131.10 | – | 0.3 ML | SARSCV2 VAC 30MCG TRS-SUC IM | v1, posted October 10, 2024 |
“Change” is the difference from the previous quarter, shown only when both quarters have a payment limit and the billing unit is the same. “vs. last quarter” and “vs. a year ago” follow the same rule.
