Coming Soon: Booster Dose for Pfizer-BioNTech COVID-19 Vaccine is Authorized for Certain Populations

Originally published October 8, 2021
Updated October 26, 2021

On October 26, 2021, Medi-Cal announced that claims for a booster dose of the Pfizer-BioNTech COVID-19 vaccine can now be processed. For the most current direction regarding eligible populations and booster dose billing guidelines, refer to the Pfizer-BioNTech COVID-19 Vaccine web page.

Effective for dates of service on or after September 22, 2021, the U.S. Food and Drug Administration (FDA) amended the Emergency Use Authorization (EUA) for the Pfizer-BioNTech COVID-19 vaccine to allow for use of a single booster dose, to be administered at least six months after completion of the primary vaccination series in certain populations.

The CDC issued recommendations for a single dose of the Pfizer-BioNTech COVID-19 vaccine six months after completion of the primary series. Eligibility guidelines for administering the Pfizer-BioNTech COVID-19 booster can be found on the Pfizer-BioNTech COVID-19 Vaccine web page.

DHCS is aggressively pursuing the necessary system and operational changes required to enable successful claims adjudication for administration of a booster dose of the Pfizer-BioNTech vaccine.

Medi-Cal will announce when the claims adjudication system is prepared to appropriately adjudicate submitted claims, as well as any additional instruction providers should utilize when billing for a Pfizer-BioNTech COVID-19 vaccine booster dose. Until then, providers are advised to administer the booster dose to the eligible populations and hold the claim submission until further notice.

For the most current information regarding Medi-Cal’s COVID-19 response, see the COVID-19 Medi-Cal Response page on the Medi-Cal Provider website.