DSHS will provide the H1N1 flu vaccine free of charge. In order to be reimbursed for the administration of the H1N1 flu vaccine, providers must include on the claim the pandemic flu vaccine procedure code 90663, which will process as informational only, and must also include the appropriate vaccine administration code.

Texas Medicaid will reimburse for administration of the intranasal or injected H1N1 vaccine. When billing with procedure code 90663 for intranasal or injection of H1N1 vaccine, providers must use injection administration procedure code 90465, 90466, 90471, or 90472. Texas Medicaid will reimburse the administration fee for up to two doses per client, any provider, when the doses are given on different dates following the Advisory Committee on Immunization Practices (ACIP) guidelines. (See www.cdc.gov//flu/professionals)

Administration of the H1N1 flu vaccine will be reimbursed separately from a THSteps visit or office visit. 

For Medicaid Managed Care, H1N1 claims for vaccines provided in a provider’s office will be submitted to the appropriate HMO.

For more information, call the TMHP Contact Center at 1-800-925-9126.