October 26, 2021
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 following COVID-19 vaccines, to allow for the administration of a heterologous (mix and match) booster dose to eligible populations:
Under these amendments, eligible individuals may choose which vaccine they receive as a booster dose. The eligible population(s) and dosing interval for the heterologous 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 of the Pfizer-BioNTech COVID-19 vaccine or Moderna COVID-19 vaccine, and providers are encouraged to bill at their earliest convenience.
DHCS is 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. Until then, providers are advised to administer the booster dose to the eligible population(s) and hold the claim submission until further notice.
Billing and eligibility guidelines for booster doses are available on the Pfizer-BioNTech COVID-19 vaccine or Moderna COVID-19 vaccine web pages. Billing and eligibility guidelines regarding booster dose administration for the Janssen COVID-19 vaccine booster dose will be provided in a future update.
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.