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

Additional COVID-19 Related Articles

Testing Guidance

Family PACT Guidance

FQHC, RHC and IHS-MOA Providers

Recipient Eligibility and Enrollment Guidance

Additional Guidance

Manual Sections

User Guides

Coronavirus (COVID-19) Uninsured Group Web Application Web Portal

Other Resources

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