COVID-19 vaccine booster updates

COVID-19 Dental Advantage Communication – July 1, 2020

On March 15, 2021, the American Dental Association entered new dental procedure codes to document the delivery of COVID-19 vaccinations upon FDA approval and as permitted under state laws governing scope of practice. Each vaccine has a unique code for administration, and allowable codes will be updated as this information is released or updated by the American Medical Association, Centers for Medicare and Medicaid Services, and Pennsylvania Department of Human Services.

UPMC Health Plan is requesting that claims be submitted via the CMS 1500 Form to the medical claim reimbursement address below. Complete the health insurance claim form.

Note: All Medicare vaccine claims should be billed to Original Medicare (FFS) through 2021.

Claim forms can be sent to the addresses noted per specific line of business.

UPMC Community HealthChoices (Medical Assistance)

UPMC Community HealthChoices
PO Box 106042
Pittsburgh, PA 15230-2995

UPMC for Kids (CHIP)

UPMC for Kids
PO Box 2999
Pittsburgh, PA 15230-2999

UPMC for You (Medical Assistance)

UPMC for You
PO Box 2995
Pittsburgh, PA 15230-2995

UPMC Health Plan (Commercial)

UPMC Health Plan
PO Box 2999
Pittsburgh, PA 15230-2999

Dental Procedure Code:	Description:
D1701	Pfizer Vaccine Admin Dose 1
D1702	Pfizer Vaccine Admin Dose 2
D1703	Moderna Vaccine Admin Dose 1
D1704	Moderna Vaccine Admin Dose 2
D1705	AstraZeneca Vaccine Admin Dose 1
D1706	AstraZeneca Vaccine Admin Dose 2
D1707	Janssen Vaccine Admin Single Dose

While use of the CMS 1500 form is encouraged, in the event a claim is submitted on an ADA dental claim form, the claim will be processed through the member’s UPMC Health Plan medical coverage.

UPMC Health Plan does not practice medicine or exercise control over the methods or professional judgments by which providers render medical services to members. Nothing in these materials should be construed to supersede or replace the clinical judgment of a provider.

Providers are responsible for appropriate billing of services. These suggested codes are not meant to provide or supersede clinical judgment.