DHCS urges physicians to hold vaccine administration claims for small children

June 28, 2022

With COVID-19 vaccines for children under age 5 now authorized for emergency use by the FDA, parents across the country are scheduling appointments to get their small children vaccinated.

The California Medical Association (CMA) today learned, however, that the California Department of Health Care Services (DHCS) has not yet completed the system and operational changes required to enable successful claims adjudication for administration of the Pfizer-BioNTech and Moderna COVID-19 vaccines for this age range.

DHCS is urging physicians to hold Medi-Cal claims for vaccine administration for children under age 5 until further notice. (Claims for all other age groups can continue to be submitted as usual.)

CMA will provide an update when the Medi-Cal claims adjudication system is prepared to appropriately process claims, as well as any additional instructions providers should utilize when billing.

For more information about billing for the COVID-19 vaccine, see CMA’s COVID-19 Vaccine Toolkit for Physician Practices and COVID-19 Vaccine Reimbursement Quick Guide.

Becoming a Vaccine Provider

It is easier than ever to be a COVID-19 vaccine provider. You don’t need an ultra-low freezer! COVID-19 vaccines can be stored with routine childhood vaccines. And offering COVID-19 vaccines with other routine vaccines increases opportunities to protect kids. Your practice or organization does need to be enrolled as COVID vaccine provider to order COVID-19 vaccines.

California is also offering grant funding to medical organizations enrolled in the federal Vaccines for Children (VFC) Program, serving eligible children from birth through 18 years of age. VFC providers newly enrolled in California's COVID-19 vaccine program (myCAvax) could be eligible for $10,000 to support enrollment and launching a vaccination center.

VFC providers already enrolled in myCAvax, who are expanding operating hours or locations, could be eligible for $15,000. Eligible providers must expand hours of operations by a minimum of 15 hours to provide additional time options for working families. For more information and to apply by July 15, 2022, visit kidsvaxgrant.org.



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