CommercialCoverageMedium impact
COVID-19 vaccines for children
UPMC Health Plan·PA · Pediatrics, Allergy & Immunology·Reimbursement
Effective date
Jul 1, 2022
We identified it
Aug 7, 2026
Summary
UPMC Health Plan has updated its COVID-19 vaccine coverage policy for children 6 months and older, including booster recommendations for children 5 years and older per CDC guidance. This is an informational and scheduling policy update that clarifies vaccine availability through UPMC's Community Pediatrics network and external scheduling options, with reference to detailed billing guidance in Appendix A of the Special Coverage and Payment Policy.
Action Required
By July 1, 2022: Billing team must review UPMC Health Plan's COVID-19 Special Coverage and Payment Policy (Appendix A) referenced in this announcement to identify applicable billing codes and reimbursement rules for pediatric COVID-19 vaccines and boosters. Front desk and scheduling staff should be aware that existing UPMC Children's Community Pediatrics patients can schedule appointments through their office, while new patients should be directed to Vaccine.UPMC.com or 1-844-876-2822 (8 a.m.–5 p.m., Monday–Friday). Update internal protocols and patient communication materials to reflect the expanded vaccine eligibility for children 6 months and older. Ensure billing systems align with any prior authorization or documentation requirements outlined in Appendix A. Failure to follow the Special Coverage and Payment Policy guidelines may result in claim denials or reimbursement delays.