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COVID-19 Vaccine Procedure Code 91323 a Benefit for Texas Medicaid and HTW Effective January 1, 2026

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Effective for dates of service on or after January 1, 2026, the COVID-19 vaccine (procedure code 91323) is a benefit of Texas Medicaid and the Healthy Texas Women (HTW) program.

Texas Medicaid

The Texas Medicaid & Healthcare Partnership (TMHP) will consider claims for vaccine procedure code 91323 and vaccine administration procedure code 90480 for clients who are 12 years of age or older for the following provider types and places of service:

Place of ServiceProvider Type
OfficePhysician, physician assistant, nurse practitioner, clinical nurse specialist, pharmacist, certified nurse midwife, registered nurse, licensed midwife, comprehensive care program (CCP) provider, nephrology (hemodialysis, renal dialysis) provider, pharmacy
HomePhysician, physician assistant, nurse practitioner, clinical nurse specialist, CCP provider, home health agency
Outpatient HospitalHospital, nephrology (hemodialysis, renal dialysis) provider, renal dialysis facility
Other LocationsPhysician, physician assistant, nurse practitioner, clinical nurse specialist, CCP provider

HTW

TMHP will consider claims for vaccine procedure code 91323 and vaccine administration procedure code 90480 for clients who are 12 years of age or older for the following provider types and places of service:

Place of ServiceProvider Type
OfficePhysician, physician assistant, nurse practitioner, clinical nurse specialist, pharmacist, certified nurse midwife, registered nurse, licensed midwife, CCP provider, family planning clinic, nephrology (hemodialysis, renal dialysis) provider, pharmacy
HomePhysician, physician assistant, nurse practitioner, clinical nurse specialist, CCP provider, home health agency
Outpatient HospitalHospital, family planning clinic, nephrology (hemodialysis, renal dialysis) provider, renal dialysis facility
Other LocationsPhysician, physician assistant, nurse practitioner, clinical nurse specialist, CCP provider

Claims Reprocessing

TMHP will reprocess any affected claims with dates of service on or after January 1, 2026. Providers may receive additional reimbursement, which will be reflected on future Remittance and Status (R&S) Reports.

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

Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to Medicaid members who are enrolled in their MCO. Administrative procedures, such as prior authorization, precertification, referrals, and claims and encounter data filing, may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should contact the member’s specific MCO for details.