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.
Beginning July 1, 2021, vaccine procedure code 90697 (Vaxelis) will become available for Texas Medicaid, Texas Health Steps, and the Children with Special Health Care Needs (CSHCN) Services Program clients. This procedure code is restricted to clients who are birth through four years of age.
Procedure code 90697 is informational only for Medicaid, Texas Health Steps and the CSHCN Services Program. Vaxelis will be available and distributed to providers free of charge through the Texas Vaccines for Children Program.
For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.