Originally published on November 4, 2021
Updated on November 5, 2021
Update: on November 5, 2021, Medi-Cal announced that claims for the administration of the primary vaccination series of the Pfizer-BioNTech COVID-19 vaccine, in children 5 through 11 years of age, can now be processed. For the most current direction regarding billing guidelines for the administration of the Pfizer-BioNTech COVID-19 primary vaccination series in children 5 through 11 years of age, refer to the Pfizer-BioNTech COVID-19 Vaccine web page.
Effective for dates of service on or after October 29, 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 the administration of the primary vaccination series to children 5 through 11 years of age, at a reduced dose.
The Department of Health Care Services (DHCS) is aggressively pursuing the necessary system and operational changes required to enable successful claims adjudication for administration of the primary vaccination series of the Pfizer-BioNTech COVID-19 vaccine in children 5 through 11 years of age.
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. Until then, providers are advised to administer the primary vaccination series to eligible children, based on recommendations from the FDA and Centers for Disease Control and Prevention (CDC), 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.