Effective retroactively for dates of service on or after the respective dates for each approved COVID-19 vaccine, providers working with individuals in the following populations may receive reimbursement for administration of the coronavirus disease 2019 (COVID-19) vaccines:

• Recipients in the Tuberculosis Program


• Family PACT recipients


• COVID-19 Uninsured Group recipients

Refer to the webpages below for billing guidance and effective dates for each vaccine:

• Pfizer-BioNTech COVID-19 Vaccine


• Moderna COVID-19 Vaccine


• Janssen COVID-19 Vaccine

Effective until December 31, 2022, Medi-Cal will waive the timeliness standard for vaccination administration claims by these providers when claims are submitted or resubmitted (electronically, or via hard copy) with the following:

• Delay Reason Code “10”


• Documentation indicating that the COVID-19 vaccine was administered are in the Remarks area of the submitted claim (for example, “COVID Vaccine administration”)

An Erroneous Payment Correction (EPC) will be implemented to reprocess any previously denied claims that were submitted by affected providers for the administration of an applicable COVID-19 vaccine. Providers may also elect to use this updated billing policy to correct and resubmit previously denied claims as described earlier in this article.

For instructions on how to submit or resubmit a claim with a delay reason code, see the following resources:

• CMS-1500:


• CMS-1500 Submission and Timeliness Instructions


• CMS-1500 Completion


• 837:


• Electronic Methods for Eligibility Transactions and Claim Submissions


• Billing Instructions: Acceptable Claims, Attachments and ASC X12N 837 v.5010 Transactions


• IPCS:


• Internet Professional Claim Submission (IPCS) User Guide

Previously, Federally Qualified Health Centers (FQHC) and Rural Health Clinics (RHC) providers were advised to hold claim submission for the administration of COVID-19 vaccines. FQHC and RHC providers are still advised to continue to hold claims. Providers will be notified when Medi-Cal is ready to accept claims from these providers.

The Centers for Medicare & Medicaid Services (CMS) issued a third set of replacement files for National Correct Coding Initiative (NCCI) Procedure-to-Procedure (PTP) edits for the first quarter of 2022. The mandatory national edits were incorporated into the Medi-Cal claims processing system and were effective for claims received on or after January 1, 2022.

No action is required by providers. An Erroneous Payment Correction (EPC) will be implemented to reprocess the affected claims, including those that were appropriately submitted based on the guidance published in this article, but erroneously adjudicated because Medi-Cal had not yet implemented the system changes to support appropriate adjudication.

More information on NCCI and this latest update can be found on The National Correct Coding Initiative in Medicaid web page.

The Centers for Medicare & Medicaid Services (CMS) has released the quarterly National Correct Coding Initiative (NCCI) payment policy updates. These mandatory national edits have been incorporated into the Medi-Cal claims processing system and are effective for claims received on or after April 1, 2022.

For additional information, refer to The National Correct Coding Initiative in Medicaid page of the Medicaid website.

Receive free one-on-one billing assistance at our Virtual Claims Assistance Room (CAR) event scheduled for the month of June.

There are multiple morning and afternoon sessions available. Providers must register through the Medi Cal Learning Portal Event Calendar.

Reminder: First time users must complete a one-time registration. Registration directions for these sessions are in a short video in the descriptive text under the “Provider Seminars and Webinars” tile on the Medi-Cal Learning Portal homepage.

Providers are encouraged to bring their more complex billing issues to a Provider Field Representative for individual assistance.

For additional assistance, please contact the Telephone Service Center (TSC) at 1-800-541-5555.

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