Pfizer-BioNTech COVID-19 Vaccine Updates for Third Dose, Booster Dose and Shortening of its Time Requirements

January 11, 2022

Effective for dates of service on or after January 3, 2022, the U.S. Food and Drug Administration (FDA) amended the Emergency Use Authorization (EUA) for the
Pfizer-BioNTech COVID-19 vaccine to allow the following:

  • Expansion of the use of a single booster dose to include individuals 12 through 15 years of age.

  • Shortening of the time between the completion of primary vaccination with Pfizer-BioNTech COVID-19 vaccine and the administration of the booster dose with an FDA approved or authorized mRNA COVID-19 vaccine to at least five months for eligible individuals.

  • The administration of a third primary series dose to certain immunocompromised children 5 through 11 years of age.

Providers can now submit claims for the administration of a booster dose in individuals12 through 15 years of age, and the administration of a booster dose at least five months after a primary series with Pfizer-BioNTech COVID-19 vaccine to eligible individuals.

The Department of Health Care Services (DHCS) will expeditiously make the necessary system and operational changes required to enable successful claims adjudication for administration of the third primary dose of the Pfizer-BioNTech COVID-19 vaccine to immunocompromised children 5 through 11 years of age once the billing code becomes available.

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 third primary dose to eligible immunocompromised individuals, based on recommendations from the FDA and Centers for Disease Control and Prevention (CDC), and hold the claim submission until further notice.

Current billing and eligibility guidelines for the booster and additional doses are available on the Pfizer-BioNTech COVID-19 Vaccine web page.

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.