August 30, 2021
The Department of Health Care Services (DHCS) has been working to expand the administration of the approved COVID-19 vaccines by ambulances who are enrolled as non-emergency medical transportation providers.
Effective retroactively for dates of service on or after the respective effective dates for each approved COVID-19 vaccine, ambulance providers may receive reimbursement for the administration of COVID-19 vaccines to eligible Medi-Cal beneficiaries. For billing guidance regarding approved vaccines as of this article’s publication, as well as effective dates for each vaccine, refer to the web pages below:
Effective until December 31, 2021, Medi-Cal will waive the timeliness standard for vaccination administration claims from ambulance providers when a claim is submitted or resubmitted with the following:
- Delay Reason Code “10”
- Documentation indicating that the COVID-19 vaccine was administered by a non-emergency medical transportation provider is in the Additional Claim Information field (Box 19) of the submitted claim (for example, “COVID Vaccine administration by Ambulance Provider”)
For more instructions on how to submit a CMS-1500 claim for to Medi-Cal that goes beyond the timeliness standards, refer to the CMS-1500 Submission and Timeliness Overview section of the appropriate Part 2 provider manual.
This policy only applies to the administration of the COVID-19 vaccine. Reimbursement for travel to and from a residence to administer the vaccine is not a part of this policy update.
An Erroneous Payment Correction (EPC) will be implemented to reprocess any previously denied claims that were submitted by ambulance 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.
This guidance is only effective for COVID-19 vaccines purchased by the federal government. At a future date, DHCS will provide an end date to this temporary policy and instruct providers on how they should bill for the reimbursement of provider purchased COVID-19 vaccines.
For billing-related questions, providers may contact the Telephone Service Center (TSC) at 1-800-541-5555, 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.
The latest information is available on Medi-Cal’s COVID-19 Response landing page.