Products billed under this code include SPIKEVAX 2024-2025 Preservative Free, SPIKEVAX 2025-26 (12Y UP) 50mcg/0.5 mL single dose SYRG.
Payment limit per 0.5 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 |
|---|---|---|---|---|
| SPIKEVAX 2024-2025 Preservative Free | Moderna | 80777-0110-93 | 10 | $1,729.67 |
| SPIKEVAX 2024-2025 Preservative Free | Moderna | 80777-0110-96 | 10 | $1,729.67 |
| SPIKEVAX 2025-26 (12Y UP) 50mcg/0.5 mL single dose SYRG | Moderna | 80777-0112-88 | 2 | $345.934 |
| SPIKEVAX 2025-26 (12Y UP) 50mcg/0.5 mL single dose SYRG | Moderna | 80777-0112-96 | 10 | $1,729.67 |
| Quarter | Payment limit | Change | Billing unit | Description | Source file |
|---|---|---|---|---|---|
| 4Q26 | $172.967 | +$11.315 | 0.5 ML | SARSCOV2 VAC 50 MCG/0.5ML IM | v1, posted September 17, 2026 |
| 3Q26 | $161.652 | $0.00 | 0.5 ML | SARSCOV2 VAC 50 MCG/0.5ML IM | v1, posted September 15, 2026 |
| 2Q26 | $161.652 | $0.00 | 0.5 ML | SARSCOV2 VAC 50 MCG/0.5ML IM | v1, posted September 15, 2026 |
| 1Q26 | $161.652 | $0.00 | 0.5 ML | SARSCOV2 VAC 50 MCG/0.5ML IM | v1, posted September 15, 2026 |
| 4Q25 | $161.652 | $0.00 | 0.5 ML | SARSCOV2 VAC 50 MCG/0.5ML IM | v1, posted September 8, 2026 |
| 3Q25 | $161.652 | $0.00 | 0.5 ML | SARSCOV2 VAC 50 MCG/0.5ML IM | v1, posted March 10, 2026 |
| 2Q25 | $161.652 | $0.00 | 0.5 ML | SARSCOV2 VAC 50 MCG/0.5ML IM | v1, posted March 10, 2026 |
| 1Q25 | $161.652 | $0.00 | 0.5 ML | SARSCOV2 VAC 50 MCG/0.5ML IM | v1, posted December 19, 2025 |
| 4Q24 | $161.652 | +$15.732 | 0.5 ML | SARSCOV2 VAC 50 MCG/0.5ML IM | v1, posted June 11, 2025 |
| 3Q24 | $145.92 | $0.00 | 0.5 ML | SARSCOV2 VAC 50 MCG/0.5ML IM | v1, posted June 11, 2025 |
| 2Q24 | $145.92 | $0.00 | 0.5 ML | SARSCOV2 VAC 50 MCG/0.5ML IM | v1, posted March 11, 2025 |
| 1Q24 | $145.92 | $0.00 | 0.5 ML | SARSCOV2 VAC 50 MCG/0.5ML IM | v1, posted December 19, 2024 |
| 4Q23 | $145.92 | – | 0.5 ML | SARSCOV2 VAC 50 MCG/0.5ML 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.
