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 April 1, 2021, reimbursement rates for COVID-19 vaccine administration procedure codes will be updated for Medicaid, the Children with Special Health Care Needs (CSHCN) Services Program, Healthy Texas Women (HTW), and Family Planning Program.
The following link shows the updates: COVID-19 Vaccine Administration Procedure Codes
TMHP will automatically reprocess affected claims, if any are identified. Providers are not required to appeal the claims unless they are denied for additional reasons after the claims reprocessing is complete.
For more information, call the TMHP Contact Center at 800-925-9126.