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FQHCs and RHCs Reimbursement for COVID-19 Vaccine Administration Services

Last updated on 4/19/2021

Beginning March 23, 2021, Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) can be reimbursed for COVID-19 vaccine administration services with procedure codes 0001A, 0002A, 0011A, 0012A, and 0031A.

These vaccine administration procedure codes are benefits for Medicaid, Children with Special Health Care Needs (CSHCN) Services Program, Healthy Texas Women (HTW), and Family Planning Program (FPP) clients when services are rendered in an office, outpatient hospital, or other location setting.

Vaccine Administration Procedure Codes Effective Dates

FQHC and RHC providers can bill retroactively for COVID-19 vaccine administration services provided on or after the effective date listed in the table below:

Procedure Code

Effective Date

0001A and 0002A

December 11, 2020

0011A and 0012A

December 18, 2020

0031A

February 27, 2021

Affected claims submitted with procedure codes and dates of service on or after the above listed effective date will be reprocessed. Providers are not required to appeal the claims unless they are denied for additional reasons after the claims reprocessing is complete. When the claims are reprocessed, providers may receive additional payment, which will be reflected on Remittance and Status (R&S) Reports.

Reimbursement

COVID-19 vaccine administration will be reimbursed outside of the prospective payment system (PPS) encounter rate when that is the only service provided on that date. If the vaccine is administered as part of an encounter, or other services are provided on the same date of service, reimbursement will only be for the encounter.

For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.