COVID-19 Vaccine Provider Frequently Asked Questions (FAQs)
The COVID-19 vaccine FAQs provides health care providers billing information for the COVID-19 vaccines for all lines of business to include Medi-Cal, CalMediConnect, L.A. Care Covered, L.A. Care Covered Direct, and PASC-SEIU. These FAQs provide guidance on who providers should bill for the administration for the COVID-19 vaccine. These FAQs will also be updated as needed with the release of new vaccine brands and CPT and administration codes.
Should you have any questions, please contact your assigned Account Manager or email L.A. Care’s Provider Relations Department.
L.A. Care appreciates your partnership and continued participation with serving L.A. Care members.
These FAQs apply to L.A. Care Medi-Cal, Cal MediConnect, L.A. Care Covered and L.A. Care Covered Direct, PASC-SEIU.
L.A. Care Health Plan will cover FDA approved or emergency use authorized COVID-19 vaccines without cost-sharing, consistent with the requirements of federal law.
Funding for the vaccine is covered by the federal government and other sources. Providers are prohibited from seeking reimbursement directly from L.A. Care beneficiaries and other individuals who are being vaccinated. Vaccination will be available to individuals at no cost to them.
Will members pay any out-of-pocket costs for the vaccine and its administration if they have not met their deductible for the year yet?
Member cost share is $0 for the vaccine and its administration. Vaccine coverage will not be subject to any deductibles.
A prior authorization is not required for the COVID-19 vaccine.
Individuals who are eligible to receive the COVID-19 vaccine are highly encouraged to get it to reduce the risk of transmission of COVID-19, severity and death. However, the vaccination for COVID-19 is a voluntary program and beneficiaries are not mandated to receive it.
- The COVID-19 vaccine and the administration costs are covered as a benefit without cost-sharing or balance billing to the beneficiary. This includes multiple doses, if required by vaccine manufacturer.
- This coverage applies to both in and out of network providers during the COVID-19 Public Health Emergency.
- Providers are prohibited from seeking reimbursement directly from individuals who are being vaccinated.
- Providers may submit claims for the reimbursement for COVID-19 administration costs to responsible payers.
(HCFA1500 or UB04)?
It depends on where the vaccine is provided. Providers should follow normal billing guidelines.
Providers may bill for COVID-19 vaccination administration fees using the following CPT and administration codes. CPT and administration codes must align by vaccine manufacturer and dose. For instance, for Pfizer, the CPT code 91300 must be used with administration codes 001A for the first dose and 002A for the second dose.