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December 2016 Texas Medicaid Provider Procedures Manual

Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook : 9 Physician : 9.2 Services, Benefits, Limitations, and Prior Authorization : 9.2.38 Postexposure Prophylaxis for Rabies

Postexposure prophylaxis for rabies procedure codes 90375, 90376, and 90675 is a benefit of Texas Medicaid. Rabies vaccine for pre-exposure procedure code 90676 is not a benefit of Texas Medicaid.
Postexposure rabies vaccine is limited to clients with diagnosis code Z203.
Animal bites to people must be reported as soon as possible to the Local Rabies Control Authority (LRCA).
Postexposure prophylaxis for rabies is not necessary following exposure to an animal that tests negative for the rabies virus.
An exposed person who has never received a complete pre- or postexposure rabies vaccine series will first receive a dose of rabies immune globulin (HRIG). This is a blood product that contains antibodies against rabies and gives immediate, short-term protection. The injection should be given in or near the wound area.
HRIG that is not administered when vaccination begins can be administered up to seven days after the administration of the first dose of vaccine. Beyond the seventh day, HRIG is not recommended since an antibody response to the vaccine is presumed to have occurred, and HRIG may inhibit the immune response to the vaccine.
The recommended dose of HRIG is 20 IU/kg body weight. This formula is applicable to all age groups, including children.
The postexposure treatment will also include five doses of rabies vaccine (1.0 ml. intramuscular). The first dose should be given as soon as possible after the exposure (day 0). Additional doses should be given on days 3, 7, 14, and 28 after the first shot. For an exposed person who has previously been vaccinated with a complete pre- or postexposure vaccine series, two doses of rabies vaccine should be given on days 0 and 3.
Health care providers, who determine their client requires the preventative rabies vaccination series after valid rabies exposure, may obtain the biologicals directly from the manufacturer or through one of the DSHS depots around the state.
Injection administration is a benefit for administration of rabies vaccine for post exposure.

Texas Medicaid & Healthcare Partnership
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