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Home Health Agency Reimbursement for COVID-19 Vaccine Administration Procedure Codes 0001A, 0002A, 0011A, 0012A, and 0031A

Last updated on 6/15/2021

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 May 18, 2021, home health agencies administering medical services for Texas Medicaid clients may be reimbursed for COVID-19 vaccine procedure codes 0001A, 0002A, 0011A, 0012A, and 0031A.

These providers may receive reimbursement for COVID-19 vaccine administration to clients who already have existing home health services or private duty nursing services, and for whom the physician has updated the care plan with orders for the COVID-19 vaccine.

Home health agencies may bill retroactively for COVID-19 vaccine administration provided on or after May 18, 2021. Claims submitted with dates of service from May 18, 2021, through May 27, 2021, 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 claims are reprocessed, providers may receive additional payment, which will be reflected on Reimittance and Status (R&S) Reports.

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