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. This table is updated as changes are made.
Pharmacy Claim Submissions
| Submission Type |
Pfizer-BioNTech |
Moderna |
Janssen |
Anything else I should know? |
| NCPDP D.0 Transactions |
Providers may submit claims as of December 29, 2020 |
Providers may submit claims as of December 29, 2020 |
Providers may submit claims as of March 3, 2021 |
No |
| Real Time Internet Pharmacy (RTIP) |
Providers may submit claims as of January 3, 2021 |
Providers may submit claims as of January 3, 2021 |
Providers may submit claims as of March 3, 2021 |
No |
| NCPDP 1.2 (Batch) |
Providers may submit claims as of January 19, 2021 |
Providers may submit claims as of January 19, 2021 |
Providers may submit claims as of March 3, 2021 |
No |
| Pharmacy Claim Form (30-1) |
Providers may submit claims as of January 19, 2021 |
Providers may submit claims as of January 19, 2021 |
Providers may submit claims as of March 3, 2021 |
No |
Medical and Outpatient Submissions
| Submission Type |
Pfizer-BioNTech |
Moderna |
Janssen |
Anything else I should know? |
| ASC X12N 837 v.5010 |
Providers may submit claims as of December 29, 2020 |
Providers may submit claims as of December 29, 2020 |
Providers may submit claims as
of March 3, 2021 |
No |
| Internet Professional Claim Submission (IPCS) |
Providers may submit claims as of December 29, 2020 |
Providers may submit claims as of December 29, 2020 |
Providers may submit claims as
of March 3, 2021 |
No |
| CMS-1500 |
Providers may submit claims as of December 29, 2020 |
Providers may submit claims as of December 29, 2020 |
Providers may submit claims as
of March 3, 2021 |
No |
| UB-04 |
Providers may submit claims as of December 29, 2020 |
Providers may submit claims as of December 29, 2020 |
Providers may submit claims as
of March 3, 2021 |
No |
Medi-Cal can now process all pharmacy, medical, and outpatient claims for the administration of 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 together on the same claim, whichever fits the provider’s billing preferences and practices.
- There is no requirement for the same provider to administer both doses. Each dose is separately reimbursable.
- The manufacturer of the doses administered to a Medi-Cal beneficiary must remain consistent between the first and second dose, regardless of the administering provider.
For specific billing guidance, providers should refer to the most current articles listed below:
Current Guidance
Previously published guidance is included below for reference:
Previously Published Vaccine Articles
Articles
Testing Guidance
Family PACT Guidance
Recipient Eligibility and Enrollment Guidance
Additional Guidance
Manual Sections
User Guides
Other Resources
