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.
This is an update to the article titled “COVID-19 Vaccine Administration Procedure Codes 0001A and 0002A Are Now Benefits,” which was posted on this website on December 14, 2020.
Effective May 10, 2021, in accordance with the Food and Drug Administration’s issuance of updated age restrictions for the Emergency Use Authorization for the Pfizer-BioNTech COVID-19 Vaccine, coverage of vaccine administration procedure codes 0001A and 0002A is expanded for Medicaid, Healthy Texas Women, Family Planning Program, and the Children with Special Health Care Needs (CSHCN) Services Program for individuals who are 12 years of age and older. Vaccine procedure code 91300 is informational only while the vaccine is distributed to providers free of charge.
For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.