COVID-19 Vaccine clinical policy update, retroactive to 10/29/2021

Washington State Health Care Authority sent this bulletin at 01/27/2022 03:27 PM PST

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Apple Health (Medicaid) Provider Alert

Attention providers

What changed?

Retroactive for claims with dates of service on and after October 29, 2021, the Health Care Authority (HCA) added the following procedure codes to the COVID-19 Vaccine Policy and Fee Schedule:

CPT® Vaccine/
Code Short Description Labeler Procedure Name

91305 SARSCOV2 VAC 30 MCG TRS-SUCR Pfizer Pfizer-BioNTech Covid-19
Pediatric Vaccine (12+ yrs)

0051A SARSCV2 VAC 30MCG TRS-SUCR1 Pfizer Pfizer Covid-19 Ped Vaccine
Admin – 1^st Dose (12+ yrs)

0052A SARSCV2 30MCG TRS-SUCR2 Pfizer Pfizer Covid-19 Ped Vaccine
Admin – 2^nd Dose (12+ yrs)

0053A SARSCV2 30MCG TRS-SUCR 3 Pfizer Pfizer Covid-19 Ped Vaccine
Admin – 3^rd Dose (12+ yrs)

0054A SARSCV2 30MCG TRS-SUCR B Pfizer Pfizer Covid-19 Ped Vaccine
Admin – Booster (12+ yrs)

HCA published a revised Apple Health (Medicaid) COVID-19 vaccine clinical policy. This document can also be found on HCA’s website under Information about novel coronavirus (COVID-19), COVID-19 testing and treatment to reflect the following update.

COVID-19 Fee Schedule

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

About the Health Care Authority (HCA)

The Washington State Health Care Authority (HCA) is committed to whole-person care, integrating physical health and behavioral health services for better results and healthier residents.

HCA purchases health care for more than 2.5 million Washington residents through Apple Health (Medicaid), the Public Employees Benefits Board (PEBB) Program, the School Employees Benefits Board (SEBB) Program, and the COFA Islander Health Care Program. As the largest health care purchaser in the state, we lead the effort to transform health care, helping ensure Washington residents have access to better health and better care at a lower cost.

Please do not reply directly to this message. For more information, visit the HCA website, where you'll also find contact information.

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Nondiscrimination

The Washington State Health Care Authority (HCA) complies with all applicable federal and Washington state civil rights laws and is committed to providing equal access to our services. Visit HCA’s website to view complete nondiscrimination statements.

COVID-19 Vaccine clinical policy update, retroactive to 10/29/2021

Apple Health (Medicaid) Provider Alert

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About the Health Care Authority (HCA)

Disclosure notice

Nondiscrimination