COVID-19 Vaccine clinical policy updates

Washington State Health Care Authority sent this bulletin at 05/31/2022 03:17 PM PDT

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Apple Health (Medicaid) Provider Alert

What changed?

New procedure code

Retroactive for claims with dates of service on and after May 17, 2022, the Health Care Authority (HCA) added the following procedure codes to the Apple Health (Medicaid) COVID-19 vaccine clinical policy and fee schedule:

CPT® Short Labeler Vaccine/Procedure

Code Description Name Name

0074A ADM SARSCV2 Pfizer Pfizer BioNTech

10MCG Covid-19 Ped

TRS-SUCR B Vaccine Admin Booster

New diagnosis code for administration of COVID-19 vaccines

Effective for claims with dates of service on and after June 1, 2022, when billing for the administration of COVID-19 vaccines, providers may use ICD diagnosis code Z71.85 and the CR modifier in the primary position on claims.

HCA revised the Apple Health (Medicaid) COVID-19 vaccine clinical policy. See HCA’s Provider billing guides and fee schedules, under COVID-19.

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 updates

Apple Health (Medicaid) Provider Alert

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About the Health Care Authority (HCA)

Disclosure notice

Nondiscrimination