Coronavirus Disease 2019 (COVID-19) Pediatric Vaccine Administration Coverage

PROVIDER ALERT

The Centers for Disease Control and Prevention (CDC) updated its recommendations regarding who is eligible to receive a COVID-19 vaccine to include children as young as six months old. The South Carolina Department of Health and Human Services (SCDHHS) is confirming that it will reimburse enrolled providers for the administration of COVID-19 vaccines to children as young as six months old, including additional doses of the COVID-19 vaccine consistent with the CDC’s guidance, for dates of service on or after June 17, 2022. The CDC is maintaining updated guidance on COVID-19 vaccines for specific groups of people, including guidance based on age, on its website.

SCDHHS will reimburse for dates of service based on the effective dates for vaccine administration established by the Centers for Medicare and Medicaid Services (CMS)

SCDHHS will adopt the billing codes, reimbursement rates and effective dates published by CMS for Medicare Part B coverage, which are available on CMS’ website.

SCDHHS will reimburse COVID-19 vaccine administration as a “bill-above” service for Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs).

Previous billing and eligibility guidance regarding COVID-19 pediatric vaccines from the agency’s Nov. 9, 2021, bulletin remains in effect. As a reminder, for Healthy Connections Medicaid members enrolled in a managed care organization (MCO), providers should bill the appropriate MCO for COVID-19 vaccine administration. Claims for fee-for-service Healthy Connections Medicaid members should be submitted to SCDHHS in the customary fashion.

The information contained in this alert is intended to provide guidance on vaccine administration coverage during the initial period of availability when the vaccine is being federally purchased and administered to Healthy Connections Medicaid members, without patient cost-sharing, who fit the criteria defined by the Food and Drug Administration and CDC.

Providers should direct any questions related to this alert to the Provider Service Center at (888) 289-0709. The Provider Service Center’s hours of operations are 7:30 a.m.-5 p.m. Monday-Thursday and 8:30 a.m.-5 p.m. Friday.

Thank you for your continued support of the South Carolina Healthy Connections Medicaid program.

Report Fraud