Family PACT Update

Effective for dates of service (DOS) on or after July 13, 2022, the U.S. Food and Drug Administration (FDA) issued an Emergency Use Authorizations (EUA) for the Novavax COVID-19 vaccine for the prevention of coronavirus disease (COVID-19) for individuals 18 years of age and older. The primary series is two doses given three weeks (21 days) apart. A third dose or booster dose is not currently authorized.

Note: Providers may submit claims for the Novavax COVID-19 vaccine on or after September 26, 2022, for date of service on or after July 13, 2022.

The effective date of this policy for Novavax codes is as follows:

Billing and eligibility guidelines are available on the Novavax COVID-19 Vaccine web page.

In addition, effective for dates of services on or after June 17, 2022, three new vaccine administration codes (0091A, 0092A, 0093A) have been assigned for the Moderna COVID-19 vaccine for pediatric patients aged 6 through 11 years of age.

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.

The Department of Health Care Services (DHCS) is publishing provider enrollment and responsibilities policy updates for the Family Planning, Access, Care, and Treatment (Family PACT) Program. The updates clarify the requirements to enroll as a Family PACT provider, including administrative responsibilities, application completion, screening, program integrity and compliance and merges policies related to Family PACT provider responsibilities into the provider enrollment section. These policy updates are effective August 15, 2022 and apply to both provider applicants and currently enrolled Family PACT providers.

On August 15, 2022, DHCS implemented the use of the Provider Application and Validation for Enrollment (PAVE) portal for Family PACT providers. The PAVE portal is a web-based application designed to simplify and accelerate enrollment processes. PAVE will provide a new mode for submitting Family PACT provider enrollment applications and required documentation to DHCS, which will continue to accept Family PACT paper or emailed applications until December 31, 2022. With this expansion, active or newly enrolled Medi-Cal fee-for-service providers who are eligible to participate in the Family PACT program will be able to enroll, make changes, recertify, and voluntarily disenroll from the Family PACT program by submitting a supplemental application via the PAVE portal.

Effective retroactively for dates of service on or after October 1, 2021, the rates for claims billed with HCPCS code J7304 and modifier U1 is as follows:

Effective retroactively for dates of service on or after October 1, 2021 thru December 31, 2021, the rate for claims billed with HCPCS code J7304 and modifier U2 is as follows:

Effective retroactively for dates of service on or after January 1, 2022, the rate for claims billed with HCPCS code J7304 and modifier U2 is as follows:

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

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

No action is required of providers. An Erroneous Payment Correction (EPC) will be implemented to reprocess the affected claims on or after the implementation date of the updated reimbursement rate. Providers may also elect to correct and resubmit previously denied claims as described in the CIF Submission and Timeliness Instructions section of the Medi-Cal Provider Manual.

Effective retroactively for dates of service on or after January 1, 2022, reimbursement rates are updated for claims billed with HCPCS code J3490 (unclassified drugs) with modifiers U6 and U8 as follows:

No action is required of providers. An Erroneous Payment Correction (EPC) will be implemented to reprocess the affected claims.

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

Note: Reimbursement rates for services billed with modifiers are not included on the Medi-Cal Rates page.

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Pages updated due to ongoing provider manual revisions: