Change to COVID-19 Vaccine Administration Maximum Allowable Rate

March 18, 2021

Effective for dates of service on or after March 15, 2021, Medi-Cal will set the maximum allowable reimbursement of the associated COVID-19 vaccine administration fee at $40.00 per dose, regardless of vaccine manufacturer. The system updates required to implement this maximum allowable reimbursement rate are forthcoming. Once the system is updated, an Erroneous Payment Correction (EPC) will be initiated to reprocess affected claims submitted prior to the system implementation of the increased maximum allowable rate, retroactive to the effective date.

For vaccines administered on dates of service prior to and including March 14, 2021, Medi-Cal will reimburse the associated COVID-19 vaccine administration fee at the previously published maximum allowable reimbursement rate for providers based on the number of required doses:

  • One dose: $28.39 upon administration

  • Two doses:
    • $16.94 upon administration of the first dose

    • $28.39 upon administration of the second dose

For billing guidance regarding the vaccines approved as of the original publication of this article, refer to the web pages below: