Family PACT Update

July 2022 | Bulletin 178


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1. Pfizer COVID-19 Vaccine Booster Dose Authorized for Individuals 5 to 11 Years of Age

Effective for dates of service on or after May 17, 2022, the Food and Drug Administration (FDA) amended the Emergency Use Authorization (EUA) for the Pfizer-BioNTech COVID-19 vaccine authorizing the use of a single booster dose for administration to individuals 5 through 11 years of age at least five months after completion of a primary series with the Pfizer-BioNTech COVID-19 Vaccine.

Providers may use administration code 0074A (immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2] [coronavirus disease (COVID-19)] vaccine, mRNA-LNP, spike protein, preservative free, 10 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation; booster dose) for billing the booster dose.

More information can be found on the Pfizer-BioNTech COVID-19 Vaccine webpage. Updated provider manual sections will be released in a future Medi-Cal Update.

Provider Manual(s) Page(s) Updated
Chronic Dialysis Clinics
Clinics and Hospitals
General Medicine
Obstetrics
Rehabilitation Clinics
Pharmacy
immun (39–47, 49–51); immun cd (6)

2. Targeted Trichomoniasis Screening Test Added as a Family PACT Benefit

Effective for dates of service on or after August 1, 2022, targeted Trichomonas vaginalis screening is a benefit under the Family Planning, Access, Care and Treatment (Family PACT) Program.

For additional information, providers can refer to the Benefits: Family Planning section in Part 2 of the manual.

Provider Manual(s) Page(s) Updated
Family PACT ben fam (54, 55); ben grid (18); lab (39, 40)

3. HPV-9 Vaccine Added as a Family PACT Clinic Benefit

Effective for dates of service on or after July 1, 2022, CPT® code 90651 (Human Papillomavirus vaccine types 6, 11, 16, 18, 31, 33, 45, 52, 58, nonvalent [9vHPV], 2 or 3 dose schedule, for intramuscular use) is a Family Planning, Access, Care and Treatment (Family PACT) Program clinic benefit for females and males 19 to 45 years of age.

Provider Manual(s) Page(s) Updated
Family PACT ben fam rel (6); ben grid (19); prog stand (11)

4. Family PACT Update for Laboratory Code 86780

Effective for dates of service on or after August 1, 2022, the Family Planning, Access, Care, and Treatment (Family PACT) Program is removing the “reflex from positive” restriction for CPT® code 86780 (Antibody test; Treponema pallidum [syphilis]) for males and females.

Provider Manual(s) Page(s) Updated
Family PACT lab (25)

5. Rates for Contraceptive Patches Billed with HCPCS Code J7304

Effective for dates of service on or after January 1, 2022, rates for claims billed with HCPCS code J7304 (contraceptive supply, hormone containing patch, each) and modifier U1 (norelgestromin and ethinyl estradiol transdermal system) or U2 (levonorgestrel and ethinyl estradiol transdermal system) are as follows:

Procedure Code with Modifier Description Rate
J7304 U1 Contraceptive supply, hormone containing patch, each (norelgestromin and ethinyl estradiol transdermal system) $40.72
J7304 U2 Contraceptive supply, hormone containing patch, each (levonorgestrel and ethinyl estradiol transdermal system) $55.40

Providers should refer to the Medi-Cal Rates page of the Medi-Cal website for other general rates information.

Note: Rates of services billed with modifiers are not included in the Rates page.

6. Update to Clinic Dispensing Policy for Certain Family Planning-Related Drugs for Family PACT and Medi-Cal Programs

Effective for dates of service on or after August 1, 2022, the dispensing frequency is updated from “one dispensing in 15 days” to “two dispensings in rolling 30 days” for the following drugs reimbursable under S5000 and S5001:

  • Cefixime

  • Cephalexin

  • Ciprofloxacin

  • Clindamycin

  • Metronidazole

  • Sulfamethoxale and Trimethoprim (SMX/TMP)

  • Tinidazole
Provider Manual(s) Page(s) Updated
Family PACT ben grid (34, 36, 40, 41); clinic (3, 4, 13, 21); drug onsite (3–7)
Clinics and Hospitals
General Medicine
Obstetrics
fam planning (25, 27, 30–32)

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