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)

• COVID-19 Vaccine Administration FAQs
• Coronavirus (COVID-19) Uninsured Group 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	Can I submit claims?	Anything else I should know?
NCPDP D.0 Transactions	Providers may submit claims as of December 29, 2020	No
Real Time Internet Pharmacy (RTIP)	Providers may submit claims as of January 3, 2021	No
NCPDP 1.2 (Batch)	Please continue to hold claim submission	No
Pharmacy Claim Form (30-1)	Please continue to hold claim submission	No

Medical and Outpatient Submissions

Submission Type	Can I submit claims?	Anything else I should know?
ASC X12N 837 v.5010	Providers may submit claims as of December 29, 2020	Claims will be put in “pending” status initially
Internet Professional Claim Submission (IPCS)	Providers may submit claims as of December 29, 2020	Claims will be put in “pending” status initially
CMS-1500	Providers may submit claims as of December 29, 2020	Claims will be put in “pending” status initially
UB-04	Providers may submit claims as of December 29, 2020	Claims will be put in “pending” status initially

Once providers are cleared to begin claim submission, they should keep in mind that possible pauses in payment should not be cause for providers to:

• Decline administering initial or second dose of the COVID-19 vaccine.
• Delay submitting claims for administration of initial or second dose of the COVID-19 vaccine.

For specific billing guidance, providers should refer to the most current articles listed below:

Current Guidance

• 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
• 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: COVID-19 Uninsured Group – Vaccine Reimbursement

Previously published guidance is included below for reference:

Previously Published Vaccine Articles

• COVID-19 Vaccine Administration: Initial and Upcoming Policy
• COVID-19 Vaccine Administration: Preparing to Electronically Submit Pharmacy Claims
• COVID-19 Vaccine Administration: Preparing to Submit Medical and Outpatient Claims

Articles

Testing Guidance

• Update to Billing Policy for Infectious Agent Antigen Detection
• Infectious Agent Antigen Detection by Immunoassay Reimbursement Rate
• COVID-19 Virus and Antibody Testing
• New Benefit for COVID-19 Detection
• Rates Are Updated for CPT COVID-19 Testing Codes 87636, 87637 and 87811
• New COVID-19 Testing Codes 87636, 87637 and 87811 Are Medi-Cal Benefits
• CPT Code 86413 Reimbursement Rate Update
• Reimbursement Rates are Updated for COVID-19 Testing
• COVID-19 Quantitative Antibody Test Added as a Medi-Cal Benefit
• CPT Codes 86408 and 86409 for COVID-19 Testing are Medi-Cal Benefits
• CPT Code for COVID-19 Testing Exempt from AB 97 10 Percent Payment Reduction
• COVID-19 Diagnostic Testing and Treatment-Related Services
• Updated Rate for New COVID-19 Diagnostic Testing CPT Code 87635
• New ICD-10-CM Diagnosis Code for COVID-19

Family PACT Guidance

• Family PACT Provider FAQs during COVID-19
• Family PACT Update: DMPA-SQ Administration Guidelines
• Update to Information on Coronavirus (COVID-19) for Family PACT Providers
• Family PACT: Virtual/Telephonic Communications
• Utilization Management for Family PACT Providers During Coronavirus

Recipient Eligibility and Enrollment Guidance

• New Available Languages for the COVID-19 Uninsured Group Application Eligibility Response
• COVID-19 Uninsured Group Program Retroactive Applications
• COVID-19 Uninsured Group Application Portal Qualified Provider Information
• Coronavirus (COVID-19) Uninsured Group Application Portal: Soft Launch
• COVID-19 Frequently Asked Questions (FAQs) Section Now Available
• PE for COVID-19 Billing Instructions for FQHCs/RHCs/IHS-MOAs
• Updated Billing Instructions for Certain COVID-19 Services
• Additional Instructions for PE for COVID-19 and PE for Pregnant Women Aid Code 7F
• Presumptive Eligibility for Pregnant Women (PE4PW) Flexibilities due to COVID-19
• Hospital Presumptive Eligibility (HPE) Flexibilities due to COVID-19
• Child Health and Disability Program (CHDP) Gateway Flexibilities due to COVID-19
• Requirements and Procedures for Emergency Medi-Cal Provider Enrollment

Additional Guidance

• DHCS Announces New Program to Enhance Hospital Capacity Amid COVID-19 Surge
• New Funding for Provider Relief Fund
• 24/7 Free Medi-Nurse Call Line for COVID-19 Questions
• Reimbursement for Associate Clinical Social Worker and Associate Marriage and Family Therapist Services for FQHCs and RHCs
• Substance Use Disorder Medication Flexibilities During COVID-19
• Updated Designation of Categorical Risk Levels for LA County Pharmacies
• Temporary Suspension of In-Person Signature Requirement for Delivered Medications
• Well-Child Visits During COVID-19
• May 2020 Medi-Cal Provider Seminar Cancelled
• DMPA-SQ Administration Guidelines Update
• Coverage of Emergency COVID-19 Inpatient or Outpatient Services
• Off-label and Investigational Drugs to Treat COVID-19
• Medi-Cal Fee-For-Service (FFS) Mitigating Health Impacts of Secondary Stress due to the 2019-Novel Coronavirus (COVID-19) Emergency
• Medi-Cal Fee-For-Service (FFS) Prior Authorization Section 1135 Waiver Flexibilities Relative to the 2019-Novel Coronavirus (COVID-19)
• Every Woman Counts (EWC) Primary Care Provider (PCP) Information Notice Program Update Regarding COVID-19 Public Health Emergency
• Paper Remittance Advice Details (RAD) Print Delay)
• Medi-Cal Fee-For-Service (FFS) Pharmacy Benefit Section 1135 Waiver Flexibilities Relative to the 2019-Novel Coronavirus (COVID-19)
• Suspension of Walk-Up Claim and Correspondence Delivery Due to COVID-19
• Notice to Providers for the Cancellation of Upcoming Provider Seminars
• State of California Coronavirus Awareness Website Launch
• Medi-Cal Payment for Telehealth and Virtual/Telephonic Communications Relative to the 2019-Novel Coronavirus (COVID-19)
• COVID-19 Medi-Cal Services and Telehealth Notice
• COVID-19 Guidance for NEMT and NMT Providers
• Fee-for-Service Pharmacy Benefit Reminders and Clarifications

Manual Sections

• Immunizations Code List (immun cd)
• Medicine: Telehealth (medne tele)
• Medical Transportation – Ground (mc tran gnd)
• Pathology: Billing and Modifiers (path bil)
• Pathology: Microbiology (path micro)
• Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) (rural)
• Indian Health Services (IHS), Memorandum of Agreement (MOA) 638, Clinics (ind health)

Other Resources

• California COVID-19 website
• California Department of Public Health (CDPH)
• Centers for Disease Control and Prevention (CDC)
• DHCS Section 1135 Waiver Request
• NCPDP Payer Sheet V5.7
• To receive ongoing updates, providers should sign up for the Medi-Cal Subscription Service (MCSS) as well.