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21-104 COVID-19 Vaccines: What You Need to Know
Effective date
Not stated in the notice
Identified
Jun 20, 2026
Summary
COVID-19 vaccines are covered at no cost to members, and the federal government pays for the vaccine itself, while providers can charge an administration fee that is billed according to line of business. Members have no copay or cost share in or out of network, prior authorization is not required, and coverage applies to all COVID-19 vaccine types. Pfizer-BioNTech (ages 16 and older) uses product code 93100 with administration codes 0001A and 0002A, and Moderna (ages 18 and older) uses product code 91301 with administration codes 0011A and 0012A.
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What to do
Action · 7 steps
01Check the current applicability of this January 2021 guidance before billing.
02Providers must record details of each vaccination in their system of record within 24 hours of administration, and in their local immunization registry within 72 hours.
03To enroll to administer vaccines, get an IIS ID from your local immunization registry, then enroll in CalVax.
04Submit Medi-Cal administration fee claims to DHCS, and submit Medicare administration fee claims to the Medicare Administrative Contractor.
05Pfizer-BioNTech doses are given three weeks (21 days) apart and bill with 0001A for the first dose and 0002A for the second.
06Moderna doses are given one month (28 days) apart and bill with 0011A for the first dose and 0012A for the second.
07Providers can report adverse events on behalf of patients through VAERS.
Codes mentioned
9310091301
Original notice
21-104 COVID-19 Vaccines: What You Need to Know
providerlibrary.healthnetcalifornia.com · Always check the source before changing claims.