The assessment grid contains the per dose assessment rate remitted by payers to the WVA. The grid contains the CPT code, NDC code, and vaccine trade name in addition to the assessment rate. Beginning with the 2020-21 grid, it includes a listing of prior discontinued NDC and CPT codes at the end of the document for legacy referencing.
The grid is updated annually and is in effect from July 1 – June 30. It is expected that providers will submit a dosage-based assessment (DBA) to the patient’s private insurance carrier or third-party administrator in the amount found on the grid, and that the carrier will remit that amount to the WVA.
To ensure proper DBA submission and carrier/TPA remittance to the WVA, please check the:
- Date of service to ensure the correct grid is being used;
- CPT code to ensure it is a valid code (*see note below); and
- Assessment amount to ensure proper DBA submission and carrier/TPA remittance to the WVA.
*Please note: Sometimes rendering providers can obtain vaccine material that is still viable and can administer it, even if it has been discontinued from prior grids and not showing on the current grid. If the CPT code is not offered on the current grid, providers should check the legacy information at the end of the grid document, and if a code was offered on a past WVA grid the last published assessment amount is what should be remitted to the WVA.