Originally published October 26, 2021
Updated October 29, 2021
Update: On October 29, 2021, Medi-Cal announced that claims for a booster Janssen COVID-19 vaccine can now be processed. For the most current direction regarding eligible populations and booster dose billing guidelines, refer to the Janssen COVID-19 Vaccine web page.
Effective for dates of service on or after October 20, 2021, the U.S. Food and Drug Administration (FDA) amended the Emergency Use Authorization (EUA) for the Janssen COVID-19 vaccine to allow for use of a single booster dose, to be administered at least two months after the single-dose primary vaccination to individuals 18 years of age or older.
DHCS is aggressively pursuing the necessary system and operational changes required to enable successful claims adjudication for administration of a booster dose of the Janssen 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 Janssen COVID-19 vaccine booster dose. Until then, providers are advised to administer the booster dose to the eligible population(s) and hold the claim submission until further notice.
Also effective for dates of service on or after October 20, 2021, eligible individuals may choose which vaccine they receive as a booster dose. The eligible population(s) and dosing interval for the heterologous (mix and match) booster dose are the same as those authorized for a booster dose of the vaccine used for primary vaccination. Medi-Cal is prepared to receive claims for the administration of a heterologous booster dose for the Pfizer-BioNTech COVID-19 Vaccine or Moderna COVID-19 Vaccine, and providers are encouraged to bill at their earliest convenience. This includes Medi-Cal recipients who have previously received the Janssen COVID-19 vaccine single dose primary vaccination.
Billing and eligibility guidelines for booster doses are available on the Pfizer-BioNTech COVID-19 Vaccine, Moderna COVID-19 Vaccine, or Janssen COVID-19 Vaccine web pages.
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.