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