Originally published October 26, 2021
Updated October 29, 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 Moderna 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.
As of the publication of this article, Medi-Cal can accept most Medical, Outpatient, and Pharmacy claims for the administration of a booster dose of the Moderna COVID-19 vaccine.
- Medical and outpatient providers may submit via either electronic or hard copy methods; whatever suits their preference.
- Outpatient claims may suspend upon submission, until required system changes are implemented to enable successful claims adjudication for the administration of a booster dose of the Moderna vaccine. Outpatient providers are encouraged to submit Outpatient claims, even if the claims may suspend.
- Pharmacy providers may only submit via NCPDP D.0 or RTIP at this time. Providers wishing to submit claims to Medi-Cal via NCPDP 1.2 (batch) or hard-copy claim methods, should hold their claims until further notice.
DHCS is aggressively pursuing the necessary required system changes to support the adjudication of Outpatient and certain Pharmacy claims, and will inform providers when the system is ready to process these claims.
For the most current direction regarding eligible populations and booster dose billing guidelines, refer to the Moderna COVID-19 Vaccine web page.
Additionally, 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 or Janssen COVID-19 vaccines, and providers are encouraged to bill at their earliest convenience.
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.
Providers with questions should contact the Telephone Service Center (TSC) Help Desk at 1-800-541-5555, 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.