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.

Pfizer-BioNTech

Dose 30-1 NCPDP D.0 RTIP NCPDP 1.2 837 v.5010 IPCS CMS-1500 UB-04
First Dose*+ Yes Yes Yes Yes Yes Yes Yes Yes
Second Dose*+ Yes Yes Yes Yes Yes Yes Yes Yes
Third Dose+ Yes Yes Yes Yes Yes Yes Yes Yes
Booster Dose+ No Yes Yes Yes Yes Yes Yes Yes

* For all approved or authorized ages
+ For all approved or authorized formulations

Moderna

Dose 30-1 NCPDP D.0 RTIP NCPDP 1.2 837 v.5010 IPCS CMS-1500 UB-04
First Dose Yes Yes Yes Yes Yes Yes Yes Yes
Second Dose Yes Yes Yes Yes Yes Yes Yes Yes
Third Dose Yes Yes Yes Yes Yes Yes Yes Yes
Booster Dose No Yes Yes Yes Yes Yes Yes Yes

Janssen

Dose 30-1 NCPDP D.0 RTIP NCPDP 1.2 837 v.5010 IPCS CMS-1500 UB-04
First Dose Yes Yes Yes Yes Yes Yes Yes Yes
Booster Dose No Yes Yes Yes Yes Yes Yes Yes

Medi-Cal can process all pharmacy, 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 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