Coronavirus Disease 2019 (COVID-19) Uninsured Group – Vaccine Reimbursement

Originally published March 8, 2021
Updated on February 24, 2022

The information below, originally published on March 8, 2021, has been updated. The updated information is outlined in the February 24, 2022, article titled “Providers Holding Submissions of Claims for COVID-19 Vaccine Administration May Now Submit” published on the Medi-Cal Providers website. Providers seeking the latest claim submission guidance from Medi-Cal for the populations addressed in this original article, should refer to the February 24, 2022, article.

The Department of Health Care Services (DHCS) submitted a federal waiver request in December 2020 to the Centers for Medicare and Medicaid Services (CMS) seeking federal approval to cover the cost of vaccine administration for beneficiaries in the COVID-19 Uninsured Group. Policy and reimbursement guidance will be updated upon additional CMS guidance and/or approvals of requested waivers. Qualified providers who have administered the COVID-19 vaccines for the COVID-19 Uninsured Group are advised at this time to hold submission of claims pending further guidance from DHCS.

For billing-related questions, providers may contact the Telephone Service Center (TSC) at 1-800-541-5555. The TSC is available 8 a.m. to 5 p.m., Monday through Friday, except holidays. Border providers and out-of-state billers billing for in-state providers should call 1-916-636-1200.