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Shingles Vaccine Procedure Code 90750 to Become a Benefit of Texas Medicaid January 1, 2019

Last updated on 11/16/2018

Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to eligible clients. Administrative procedures such as prior authorization, pre-certification, referrals, and claims/encounter data filing may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should contact the client's specific MCO for details.

Effective for dates of service on or after January 1, 2019, shingles vaccine procedure code 90750 will become a benefit for clients who are 50 years of age and older as follows:

Place of Service

When Services are Provided by

Office

Nurse practitioner, clinical nurse specialist, physician assistant, physician, pharmacy, pharmacist, and certified nurse midwife providers

Home

Nurse practitioner, clinical nurse specialist, physician assistant, physician, and federally qualified health center providers

Outpatient hospital

Hospital providers

Other location

Nurse practitioner, clinical nurse specialist, physician assistant, and physician providers

Note: New benefits that are adopted by Texas Medicaid must complete the rate hearing process to receive public comment on proposed Texas Medicaid reimbursement rates. After the rate hearing, expenditures must be approved before the rates are adopted by Texas Medicaid.

For more information, call the TMHP Contact Center at 800-925-9126.