DATE: October 12, 2023
TO: WVA Providers and Payers
The COVID-19 vaccine commercialization took effect on September 14, 2023. Providers can order vaccines and must, in turn, use the WVA’s Dosage-Based Assessment (DBA) billing process for commercially insured patients under the age of 19. This includes commercial payers and third-party administrators (TPAs). COVID-19 is now no different than any other vaccine covered on the WVA Vaccine Assessment Grid.
The WVA Vaccine Assessment Grid has been updated to include COVID-19 vaccines. Additional COVID-19 vaccines may be added in the future, so please refer to this web page for the most current information. Until June 30, 2024, all COVID-19 vaccines will have a Vaccine Assessment Grid amount of $105.00. It is expected that this will be re-evaluated for any July 2024 Vaccine Assessment Grid updates.
- The RSV monoclonal antibody – Beyfortus™ (nirsevimab) – is part of Washington State’s Childhood Vaccine Program (CVP) for the 2023/24 RSV season but IS NOT currently part of the WVA Vaccine Assessment Grid. No dosage-based assessment (DBA) is required. Funding will be through the WVA’s reserves.
- Thus state-supplied vaccine through the CVP IS available for commercially insured patients in Washington States
- There IS State-supplied vaccine through the VFC program available for Medicaid Apple Health patients in Washington State.
- Providers SHOULD NOT bill Beyfortus™ vaccine codes using the WVA’s dosage-based assessment (DBA) process until it is added to the WVA Vaccine Assessment Grid, likely next year.
- Providers SHOULD work directly with the patient’s insurance carrier or TPA for reimbursement of the administration fee.
WA DOH CONTACT POINTS FOR PROVIDERS can be found here:
WVA CONTACT POINTS:
firstname.lastname@example.org for Payers
email@example.com for Providers