COVID-19 Vaccine Administration: Real-Time NCPDP D.0 Pharmacy Claims Submission Reminders

As announced in the COVID-19 Vaccine Administration: Real-Time NCPDP D.0 Pharmacy Claims Can Be Submitted article, pharmacy providers may begin submitting claims in accordance with published instruction.

Now that Real-Time NCPDP D.0 claims submission has begun, Medi-Cal would like to remind pharmacy providers of the following:

• Pharmacy providers may begin administration of the vaccine in accordance with the CDPH Allocation Guidelines for COVID-19 Vaccine During Phase 1A.


• Providers must keep the manufacturer consistent between doses; if the first dose administered to a patient is the Pfizer-BioNTech vaccine, then the second dose administered to the same patient must also be the Pfizer-BioNTech vaccine.


• At this time, only two NDC codes may be used. Refer to the COVID-19 Vaccine Administration: Preparing to Electronically Submit Pharmacy Claims article for additional details.


• Pfizer-BioNTech COVID-19 Vaccine: NDC 59267100001


• Moderna COVID-19 Vaccine: NDC 80777027310


• Pharmacy providers are expected bill exclusively with the NDCs depicted above and adhere to the updated Medi-Cal’s NCDP Payer Sheet V5.7. Other notable NCPDP D.0 submission details that providers should refer to are included in the COVID-19 Vaccine Administration: Preparing to Electronically Submit Pharmacy Claims article.

If these instructions are not followed, pharmacy providers should anticipate claim rejection or possibly incorrect payment amounts.

For further information, refer to the COVID-19 Vaccine Administration article series regarding California’s COVID-19 vaccination plan, and the Department of Health Care Services (DHCS) delivery support.