Family PACT Update

June 2022 | Bulletin 177


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1. Update: Second Booster Dose for Select COVID-19 Boosters Now a Benefit

Effective for dates of service (DOS) on or after March 29, 2022, the U.S. Food and Drug Administration (FDA) amended the Emergency Use Authorization (EUA) for the Pfizer-BioNTech COVID-19 vaccine and Moderna COVID-19 vaccine, to allow for use of a second booster dose, to be administered at least four months after initial booster dose, to the following groups for each respective vaccine:

Pfizer-BioNTech:

  • Individuals 12 years of age or older with certain kinds of immunocompromise. This includes individuals who have undergone solid organ transplantation, or who are living with conditions that are considered to have an equivalent level of immunocompromise.

  • Individuals 50 years of age and older.

Moderna:

  • Individuals 18 years of age or older with certain kinds of immunocompromise. This includes individuals who have undergone solid organ transplantation, or who are living with conditions that are considered to have an equivalent level of immunocompromise.

  • Individuals 50 years of age and older.

Providers may now submit claims for second booster dose administration using the following codes:

  • Pfizer:

    • Administration Code 0004A for the originally authorized formulation (phosphate buffered saline)

    • Administration Code 0054A is for the Tris buffered formulation

  • Moderna:

    • Administration Code 0064A

    • Administration Code 0094A for new booster formulation (50 mcg/0.5 ml)

Billing:

Providers can now bill for administration code 0094A. A booster dose of any manufacturer cannot be billed for the same recipient more than once on the same DOS.

For the most current information regarding Medi-Cal’s COVID-19 response, see the COVID-19 Medi-Cal Response page on the Medi-Cal Provider website.

Provider Manual(s) Page(s) Updated
Chronic Dialysis Clinics
Clinics and Hospitals
General Medicine
Obstetrics
Pharmacy
Rehabilitation Clinics
immun (41, 42, 44, 45); immun cd (5)

2. HAP Client Eligibility System Updated to Capture Modality Used for Enrollment

Effective June 10, 2022, the Health Access Programs (HAP) client eligibility system will be updated to capture the modality used to enroll applicants or recertify clients in the Family Planning, Access, Care and Treatment (Family PACT) Program. Family PACT providers must denote the modality used to enroll applicants or recertify clients on the Client Eligibility Certification (CEC) form and in the HAP system.

Additionally, an updated CEC form will be made available on the Department of Health Care Services (DHCS) website upon the effective date.

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4. Provider Manual Revisions



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