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December 2016 Texas Medicaid Provider Procedures Manual

Children’s Services Handbook : Appendix B. Immunizations : B.3 General Recommendations : B.3.2.2 Immunizations (Vaccine/Toxoids)

B.3.2.2
The following vaccines and toxoids are a benefit of Texas Medicaid:
 
Number of Components**
Number of Components**
Number of Components**
Providers may use the state-defined modifier U1 in addition to the associated administered vaccine procedure code for clients who are birth through 18 years of age and the vaccine was unavailable through TVFC.
 
Note:
“Unavailable” is defined as a new vaccine approved by ACIP that has not been negotiated or added to a TVFC contract, funding for new vaccine that has not been established by TVFC, or national supply or distribution issues. Providers will be informed if a vaccine meets the definition of ‘not available’ from TVFC and when the provider’s privately purchased vaccine may be billed with modifier U1.
Modifier U1 may not be used for failure to enroll in TVFC, maintain sufficient TVFC vaccine/toxoid inventory, or for clients who are 19 through 20 years of age.

Texas Medicaid & Healthcare Partnership
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