On September 11, 2023, the United States Food and Drug Administration (FDA) authorized updated COVID-19 vaccines to target the currently circulating Omicron XBB.1.5 variant. As of September 12, 2023, the Centers for Disease Control and Prevention (CDC) recommends the 2023-2024 updated COVID-19 vaccines for everyone six months of age and older to protect against serious illness from COVID-19.
Additionally, with the updated vaccine, the federal government is no longer purchasing COVID-19 vaccines, requiring physicians to buy and bill as they do other vaccines.
Effective for dates of service on or after September 11, 2023, the vaccines and administration fee for the commercialized COVID-19 vaccines is reimbursable as a Medicare benefit.
Noridian, the Medicare Administrative Contractor, completed the necessary system and operational changes to allow for adjudication of claims for the new commercial COVID-19 vaccines without any claim delays.
Reimbursement rates for the new vaccines can be found on the CMS website. To see your geographically adjusted reimbursement rate for the new vaccine administration code (CPT 90480), click “COVID-19 Vaccines & Monoclonal Antibodies, scroll to “Geographically-adjusted Payment Rates” and find your region.
For more information, see the 2023-2024 Commercialized COVID-19 Vaccines Medi-Cal Policy Update.