COVID-19 Vaccine clinical policy update

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Apple Health (Medicaid) Provider Alert

Attention providers

What changed? 

Retroactive to dates of service on and after December 8, 2022, the Health Care Authority (HCA) added the following COVID vaccine procedure codes to the Apple Health (Medicaid) COVID-19 vaccine clinical policy and fee schedule:

CPT® or
HCPCS code            Short description                               Labeler

91316                      SARSCOV2 VAC BVL 10MCG/0.2ML       Moderna

0164A                      ADM SRSCV2 BVL 10MCG/0.2ML B       Moderna

91317                      SARSCOV2 VAC BVL 3MCG/0.2ML         Pfizer

0173A                      ADM SARSCV2 BVL 3MCG/0.2ML 3       Pfizer

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

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 2021 American Medical Association.