COVID-19 vaccine clinical policy updates

Washington State Health Care Authority sent this bulletin at 10/09/2023 03:49 PM PDT

October 9, 2023

Apple Health (Medicaid) Provider Alert

Attention clinician and hospital providers

What changed?

COVID-19 vaccines are no longer federally purchased. Retroactive to dates of service on and after September 11, 2023, the Health Care Authority (HCA) reimburses for only the COVID-19 vaccine and administration codes listed in the following table. The table also indicates the fee schedule where the information for each COVID-19 vaccine and administration code is found.

_CPT® code	_{Short Description}	_{Physician-related/ professional services fee schedule}	_{Professional administered drug fee schedule}	_{Outpatient hospital fee schedule}
91318	_{SARSCOV2 VAC 3MCG TRS-SUC}		X	X
91319	_{SARSCV2 VAC 10MCG TRS-SUC IM}		X	X
91320	_{SARSCVB2 VAC 30 MCG TRS-SUC IM}		X	X
91321	_{SARSCOV2 VAC 30 MCG TRS-SUC IM}		X	X
91322	_{SARSCOV2 VAC 50MCG/0.5ML IM}		X	X
91304	_{SARSCOV2 VAC 5MCG/0.5 ML IM}		X	X
90480*	_{ADMIN SARCOV2 VACC 1 DOSE}	X		X
M0201	_{Covid-19 vaccine}_{home admin}		X	X

* Previously there were vaccine-specific administration codes. This is now the only vaccine administration code in non-home settings.

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

Fee Schedules

HCA’s fee schedules are located on HCA’s Billers and Provider’s web page, Professional Billing Guides/Fee Schedules, under Outpatient Hospital, Physician-related/professional services, or Professional administered drugs.

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