COVID-19 Vaccine clinical policy updates, effective 6/17/2022

Washington State Health Care Authority sent this bulletin at 07/13/2022 02:52 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 June 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 for clients ages 6 months to 4 years:

CPT® Code	Short Description	Labeler Name	Vaccine/ Procedure Name
91308	SARCOV2 VAC 3MCG TRS-SUCR	Pfizer	Pfizer-BioNTech COVID-19 Pediatric Vaccine (Aged 6 Months through 4 years)(Maroon Cap) - Administration
0081A	ADM SARSCOV2 TRS-SUC 1	Pfizer	Pfizer-BioNTech COVID-19 Pediatric Vaccine (Aged 6 Months through 4 years) (Maroon Cap) - Administration– First dose
0082A	ADM SARCOV2 TRS-SUCR 2	Pfizer	Pfizer-BioNTech COVID-19 Pediatric Vaccine (Aged 6 Months through 4 years) (Maroon Cap) - Administration–Second dose
0083A	ADM SARSCOV2 TRS-SUCR 3	Pfizer	Pfizer-BioNTech COVID-19 Pediatric Vaccine (Aged 6 Months through 4 years) (Maroon Cap) - Administration– Third dose

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, effective 6/17/2022

Apple Health (Medicaid) Provider Alert

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About the Health Care Authority (HCA)

Disclosure notice

Nondiscrimination