COVID-19 vaccine clinical policy updates re-release

Washington State Health Care Authority sent this bulletin at 10/11/2023 04:51 PM PDT

October 12, 2023

Apple Health (Medicaid) Provider Alert

Attention clinician and hospital providers

What changed?

Note: This is a rerelease of the Provider Alert sent out on October 9, 2023. HCA is rereleasing it due to a publication error making the table unreadable.

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 10 MCG TRS-SUC IM		X	X

91320	SARSCVB2 VAC 30MCG TRS-SUC IM		X	X

91321	SARSCOV2 VAC 25MCG/0.25ML 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 re-release

Apple Health (Medicaid) Provider Alert

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About the Health Care Authority (HCA)

Disclosure notice

Nondiscrimination