October 17, 2023
The California Medical Association has been made aware of a Department of Health Care Services (DHCS) system issue that caused erroneous denials for four COVID-19 vaccine administration codes approved for use on April 18, 2023:
- 0121A-Pfizer bivalent vaccine for 12+ yrs old single dose
- 0141A-Moderna bivalent pediatric vaccine for 6 months – 11 yrs old first dose
- 0142A-Moderna bivalent pediatric vaccine 6 months – 11 yrs – second dose
- 0151A-Pfizer bivalent pediatric vaccine 5-11 yrs old single dose
The system issue affected all claims submitted with these four codes. DHCS updated its system at the end of September 2023 and advised that an Erroneous Payment Correction (EPC) will be implemented to automatically reprocess the claims that erroneously denied with RAD Code 0037. CMA is waiting to hear back from DHCS on the timing of the EPC.
Physicians do not need to resubmit claims. However, if physicians do not want to wait on the EPC they may resubmit as original submissions as long as the dates of service are within the six-month billing limit.