Updates to the COVID-19 vaccine clinical policy, eff 10/29/2021

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Apple Health (Medicaid) Provider Alert

Attention providers

What changed?

Retroactive to claims with dates of service on and after October 29, 2021, the Health Care Authority (HCA) updated the Apple Health (Medicaid) COVID-19 vaccine clinical policy.

Specifically, HCA added the following procedure codes to the COVID Vaccine and Vaccine Administration table:

CPT® Code

 Short Description

Labeler Name

 Vaccine/
Procedure Name

 91307

 SARSCOV2 VAC
 10 MCG TRS-SUCR

Pfizer

 Pfizer-BioNTech 
 Covid-19
 Pediatric Vaccine

 0071A

 ADM SARSCV2
 10 MCG TRS-SUCR 1

Pfizer

 Pfizer-BioNTech 
 Covid-19
 Pediatric Vaccine
  – Administration
 – First dose

 0072A

 ADM SARSCV2
 10 MCG TRS-SUCR 2

Pfizer

 Pfizer-BioNTech
 Covid-19 
 Pediatric Vaccine
 – Administration
 – Second dose

COVID-19 Fee Schedule

HCA revised the Emergency COVID-19 Fee Schedule. See HCA’s Provider billing guides and fee schedules, under COVID-19.

CPT® codes and descriptions only are copyright 2020 American Medical Association.