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Reimbursement Rate Updates for Procedure Code M0245

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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 March 4, 2021, for dates of service on or after February 9, 2021, the reimbursement rate for procedure code M0245 has been updated for Texas Medicaid.

The following link shows procedure code M0245 updates: COVID-19 Vaccine Administration Codes (effective February 09, 2021)

Affected claims with dates of service from February 9, 2021, through March 4, 2021, if any are identified, will be reprocessed. Providers are not required to appeal the claims unless they are denied for additional reasons after the claims reprocessing is completed.

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