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Vaccine Codes, Medi-Cal Rx and Clear as Mud Podcast

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AMA Update on Vaccine Codes

The American Medical Association (AMA) published an update to the Current Procedural Terminology (CPT®) code set that includes new vaccine-specific codes to report immunizations for the novel coronavirus (SARS-CoV-2).

Working closely with the Centers for Disease Control and Prevention, the CPT Editorial Panel has approved a unique CPT code for each of two coronavirus vaccines as well as administration codes unique to each such vaccine. The new CPT codes clinically distinguish each coronavirus vaccine for better tracking, reporting and analysis that supports data-driven planning and allocation. Importantly, these CPT codes are available prior to the public availability of the vaccines to facilitate updating of health care electronic systems across the U.S.

The new Category I CPT codes and long descriptors for the vaccine products are:

  • 91300: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3mL dosage, diluent reconstituted, for intramuscular use
  • 91301: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 100 mcg/0.5mL dosage, for intramuscular use

In accordance with the new vaccine-specific product CPT codes, the CPT Editorial Panel has worked with the Centers for Medicare and Medicaid Services to create new vaccine administration codes that are both distinct to each coronavirus vaccine and the specific dose in the required schedule. This level of specificity is a first for vaccine CPT codes, but offers the ability to track each vaccine dose, even when the vaccine product is not reported (e.g. when the vaccine may be given to the patient for free). These CPT codes report the actual work of administering the vaccine, in addition to all necessary counseling provided to patients or caregivers and updating the electronic record.

The new vaccine administration CPT codes and long descriptors are:

  • 0001A: Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3mL dosage, diluent reconstituted; first dose
  • 0002A: Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3mL dosage, diluent reconstituted; second dose
  • 0011A: Immunization administration by intramuscular injection of Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 100 mcg/0.5mL dosage; first dose
  • 0012A: Immunization administration by intramuscular injection of Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 100 mcg/0.5mL dosage; second dose

All of these new CPT codes will be available for use when these coronavirus vaccines receive Emergency Use Authorization or approval from the Food and Drug Administration.

 

Medi-Cal Rx

Physicians who write prescriptions for Medi-Cal patients must sign up for the state’s new Medi-Cal Rx portal before Jan. 1, 2021, as the state works to improve access to pharmacy benefits and standardize the Medi-Cal pharmacy benefit statewide.

Physicians are encouraged to start the registration process as soon as possible, to ensure their ability to prescribe for Medi-Cal patients is not interrupted. The first step in the registration process is to request a PIN, which will be sent via mail to the address on record with Medi-Cal. The letter with the PIN can take up to 10 days to arrive.

Prescribers will also need training on the new portal, which is offered for free by the California Department of Health Care Services (DHCS). For detailed registration and training instructions, click here.

As one of his first acts as governor, Gavin Newsom issued an executive order aimed at achieving cost savings for drug purchases made by the state. A key component of the order requires DHCS to transition all Medi-Cal pharmacy services from managed care to fee for service (FFS) by January 1, 2021. The Medi-Cal pharmacy benefits and services administered by DHCS in the FFS delivery system are collectively referred to as “Medi-Cal Rx.”

Medi-Cal Rx will include all pharmacy services billed as a pharmacy claim, including physician administered drugs (PADs). However, PADs billed on medical or institutional claims are excluded from the requirement to transition to Medi-Cal Rx and should not be affected.

Under the Medi-Cal Rx program, physicians will use a secure provider web portal for key prescribing functions, such as:

  • Prior authorization information and submittal instructions
  • Beneficiary eligibility look up
  • Web claims submission, activities, and inquiries

More information on the Medi-Cal Rx transition and the provider portal can be found at medi-calrx.dhcs.ca.gov/home.

 

New ‘Clear as Mud’ Podcast


We are officially launching the new Clear as Mud podcasts this week featuring Dr. Cesar Chavarria, Dr. Dave Logan and Francisco Silva, general counsel, CMA. To access the site click here.

Click below to find the Clear as Mud podcast on your favorite platform, or just search Clear as Mud. Please subscribe, rate the episodes and comment on anything that stood out to you!
 
Listen to Podcast
 

New PPE Distribution Program

Pleased to share news on a new program that distributes PPEs. The PPE Unite™ program distributes valuable face masks, hand sanitizer, and face shields to eligible small businesses in the County of Los Angeles.

Sign up is simple and it is easy to schedule a pickup. Certain rules and eligibility requirements apply here.
 
 

Practices: Small Clinics Face Losses and Closures

LACMA's secretary Dr. Jerry P. Abraham was featured in the Los Angeles Business Journal to provide his perspective on the losses and closures primary care clinics are experiencing.
 

Read the full article below.

View Article Part I
View Article Part 2
 

Your Chance to Win PPE!

 

We are raffling off 2 boxes of PPE every 2 weeks until December 31, 2020.  There will be 2 winners (every 2 weeks) and each box contains a 2 month supply of PPE valued at nearly $4,500.

Eligibility:
Individual self-paying members are eligible for this raffle. 

How to enter:
To be eligible for this raffle, simply renew your annual membership online or send in your renewal check in the mail and you will automatically be entered for the raffle drawing during that 2-week time frame.  Please note that your name will be entered for only one raffle.

Winner Announcement:
You will receive an email from Lisa Le informing you that you’ve won.
 

Questions?
Email Lisa Le at lisa@lacmanet.org

Enter the current raffle now by clicking the renewal link below.

Renew Membership
 

#MondayMotivation



"Being a good person doesn’t depend on your religion, your race or your skin color or your culture. It depends on how good is your heart and how good you treat others."


Gustavo Friederichsen
Chief Executive Officer
Los Angeles County Medical Association
“If it matters to our LACMA members, it matters to me.”