COVID-19 Medi-Cal Response
The Department of Health Care Services (DHCS) continues to closely monitor and respond to COVID-19 and is providing information on this web page to all providers as a reminder of recommended safety procedures and protocols from the federal Centers for Disease Control and Prevention (CDC) and California Department of Public Health (CDPH) to help prevent spread of COVID-19. Providers are encouraged to check this page for regular updates to the Medi-Cal response to COVID-19, as well as the Medi-Cal homepage.
Frequently Asked Questions (FAQs)
Vaccine Administration
Current Direction on Claims Submission
To assist providers with claims submission for the administration of the COVID-19 vaccine, Medi-Cal has provided a summary of the most current direction that providers are being asked to follow regarding the various submission methods that Medi-Cal accepts. This table is updated as changes are made to the claims adjudication system, to allow for more submission methods to be used to submit COVID-19 vaccine administration claims.
Pharmacy providers seeking to submit hardcopy or electronic claims should refer to the Medi-Cal Rx website for submission and billing instructions.
Pfizer-BioNTech
Dose |
837 v.5010 |
IPCS |
CMS-1500 |
UB-04 |
First Dose |
Yes |
Yes |
Yes |
Yes |
Second Dose |
Yes |
Yes |
Yes |
Yes |
Third Dose |
Yes |
Yes |
Yes |
Yes |
First Booster Dose |
Yes |
Yes |
Yes |
Yes |
Second Booster Dose |
Yes |
Yes |
Yes |
Yes |
Refer to the Pfizer-BioNTech Vaccine Guidelines web page for specific age restrictions and formulations that Medi-Cal currently supports.
Moderna
Dose |
837 v.5010 |
IPCS |
CMS-1500 |
UB-04 |
First Dose |
Yes |
Yes |
Yes |
Yes |
Second Dose |
Yes |
Yes |
Yes |
Yes |
Third Dose |
Yes |
Yes |
Yes |
Yes |
First Booster Dose |
Yes |
Yes |
Yes |
Yes |
Second Booster Dose |
Yes |
Yes |
Yes |
Yes |
Refer to the Moderna Vaccine Guidelines web page for specific age restrictions and formulations that Medi-Cal currently supports.
Note:
Medi-Cal currently cannot process the Moderna formulation defined under CPT code 0094A.
Janssen
Dose |
837 v.5010 |
IPCS |
CMS-1500 |
UB-04 |
First Dose |
Yes |
Yes |
Yes |
Yes |
Booster Dose |
Yes |
Yes |
Yes |
Yes |
Refer to the Janssen Vaccine Guidelines web page for specific age restrictions and formulations that Medi-Cal currently supports.
Novavax
Dose |
837 v.5010 |
IPCS |
CMS-1500 |
UB-04 |
First Dose |
Yes |
Yes |
Yes |
Yes |
Second Dose |
Yes |
Yes |
Yes |
Yes |
Refer to the Novavax Vaccine Guidelines web page for specific age restrictions and formulations that Medi-Cal currently supports.
Medi-Cal can process all medical and outpatient claims for the administration of the primary vaccination series for currently approved or authorized COVID-19 vaccines. Any prior pauses in payment:
- Should not be cause for providers to decline administering initial or secondary doses of currently approved COVID-19 vaccines.
- Should not delay timely submission of COVID-19 vaccine administration claims.
Additionally, providers are reminded that:
- Dose administrations may be billed separately, or multiple on the same claim, whichever fits the provider’s billing preferences and practices. Claims submitted should adhere to the timeliness guidelines described in the Part 1 provider manual section, Claim Submission and Timeliness Overview.
- There is no requirement for the same provider to administer all doses. Each dose is separately reimbursable.
- The manufacturer of the doses administered to a Medi-Cal beneficiary must remain consistent between the primary vaccination series doses, regardless of the administering provider.
- Eligible individuals may choose which vaccine they receive as a booster dose. The eligible population(s) and dosing interval for the heterologous (mix and match) booster dose are the same as those authorized for a booster dose of the vaccine used for primary vaccination.
For specific billing guidance, providers should refer to the most current articles listed below:
Current Vaccine Guidance
Current Monoclonal Antibody Guidance
Recently Published Vaccine or Therapeutics Articles
Family PACT Client Enrollment Policy Update
Evusheld No Longer Authorized to Prevent COVID-19
Expanded Use of Bivalent Dosages Approved for Children Six Months and Up
Bebtelovimab No Longer Authorized to Treat COVID-19
TAR Requirement Removal and FDA Approvals for Veklury®
Coming Soon: Expanded Use of Bivalent Dosages Approved for Children 6 Months and Up
Booster Dose for Novavax and Pediatric Bivalent Pfizer-BioNTech and Moderna COVID-19 Vaccines
Coming Soon: Booster Dose for Novavax and Pediatric Bivalent Pfizer-BioNTech and Moderna COVID-19 Vaccines
Policy Update and Billing Guidance for COVID-19 Oral Antiviral, Paxlovid
Billing Update for Bebtelovimab Use for COVID-19 Treatment
Addition of Novavax COVID-19 Vaccine
Coming Soon: Bivalent Booster Dose for Select COVID-19 Vaccines
Reminder: COVID-19 Oral Antivirals for Uninsured Group
Coming Soon: Novavax COVID-19 Vaccine Authorization
FDA Approves COVID-19 Vaccine for Children 6 Months and Up
Coming Soon: COVID-19 Vaccine for Children 6 Months and Up
Pfizer COVID-19 Vaccine Booster Dose Approved for Individuals 5 to 11 Years Old
Second Booster Dose for Select COVID-19 Boosters Now a Benefit
Update: FQHC, RHC and Tribal FQHC Providers Claim Submission for COVID-19 Vaccine Administration
Coming Soon: Second Booster Dose for Select COVID-19 Vaccines
Bebtelovimab Administration added as New COVID-19 Monoclonal Antibody Benefit
Providers Holding Submissions of Claims for COVID-19 Vaccine Administration May Now Submit
Home Health Agency Providers May Be Reimbursed for COVID-19 Vaccine Administration
Pharmacy Providers to Bill Medi-Cal Rx for COVID-19 Vaccine Administration
New Public Health Order requires workers in adult and senior care facilities and in-home direct care settings to be vaccinated by November 30
COVID-19 Vaccination Administration Reimbursable for Ambulance Providers
Supplemental Rate for Administration of COVID-19 Vaccine in Home Setting
Previously Published Vaccine or Monoclonal Antibody Articles
FQHC, RHC and Tribal FQHC Providers May Now Submit Claims for COVID-19 Vaccine Administration
Sotrovimab No Longer Authorized to Treat COVID-19
Pfizer-BioNTech COVID-19 Vaccine Updates for Third Dose, Booster Dose and Shortening of its Time Requirements
Eligibility of Pfizer-BioNTech COVID-19 Booster Dose Expanded to 16 Years of Age and Older
Eligibility of COVID-19 Booster Doses Expanded to All Adults
Pfizer-BioNTech COVID-19 Vaccine for Children 5 through 11 Can Be Processed
Booster Dose for Janssen COVID-19 Vaccine Can Be Processed
Heterologous (Mix and Match) COVID-19 Vaccine Booster Doses are Authorized
Booster Dose for Moderna COVID-19 Vaccine Can Be Processed
Booster Dose for Pfizer-BioNTech COVID-19 Vaccine Can Be Processed
Third Dose for Pfizer-BioNTech and Moderna COVID-19 Vaccines: Pharmacy Batch and Hard Copy Claims
Coming Soon: Pfizer-BioNTech COVID-19 Vaccine is Authorized for Children 5 through 11
Coming Soon: Booster Dose for Janssen COVID-19 Vaccine is Authorized
Coming Soon: Booster Dose for Pfizer-BioNTech COVID-19 Vaccine is Authorized for Certain Populations
Third Dose for Pfizer-BioNTech and Moderna COVID-19 Vaccines Can Be Processed
Third Dose for Pfizer-BioNTech and Moderna COVID-19 Vaccines Authorized for Certain Populations
Coming Soon: Third Dose for Pfizer-BioNTech and Moderna COVID-19 Vaccines Authorized
New Age Restriction for Pfizer-BioNTech COVID-19 Vaccine
New NDC for Moderna COVID-19 Vaccine
Reimbursement for COVID-19 Vaccine-Only Visits for IHS-MOA Providers
COVID-19 Vaccine Administration: Specific Groups Advised to Hold Claim Submission
Change to COVID-19 Vaccine Administration Maximum Allowable Rate
Vaccines for People with High-Risk Medical Conditions or Disabilities
Coronavirus Disease 2019 (COVID-19) Uninsured Group – Vaccine Reimbursement
COVID-19 Vaccine Administration: COVID-19 Uninsured Group – Vaccine Reimbursement
COVID-19 Vaccine Administration: Initial and Upcoming Policy
COVID-19 Vaccine Administration: Preparing to Submit Medical and Outpatient Claims
COVID-19 Vaccine Administration: Preparing to Electronically Submit Pharmacy Claims
COVID-19 Vaccine Administration: Real-Time NCPDP D.0 Pharmacy Claims Can Be Submitted
COVID-19 Vaccine Administration: Medical and Outpatient Claims Can Be Submitted
COVID-19 Vaccine Administration: Pharmacy Batch and Hard Copy Claims Can Be Submitted
COVID-19 Vaccine Administration: Medical and Outpatient Claims Now Adjudicating
COVID-19 Vaccine Administration: Preparing NCPDP 1.2 and Pharmacy Hard Copy Submissions
COVID-19 Vaccine Administration: Real-Time RTIP Pharmacy Claims Can Be Submitted
COVID-19 Vaccine Administration: Real-Time NCPDP D.0 Pharmacy Claims Submission Reminders
Additional COVID-19 Related Articles
Testing Guidance
Family PACT Guidance
FQHC, RHC and IHS-MOA Providers
Recipient Eligibility and Enrollment Guidance
Additional Guidance
Over-the-Counter COVID-19 Antigen Test Kits
Manual Sections
Other Resources