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COVID-19 Vaccine Administration Procedure Codes 0003A and 0013A Are Now Benefits

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Effective for dates of service on or after August 12, 2021, in accordance with the Food and Drug Administration’s amended Emergency Use Authorization, COVID-19 vaccine administration codes 0003A (Pfizer-BioNTech) and 0013A (Moderna) are now benefits of Medicaid, Healthy Texas Women (HTW), the Family Planning Program (FPP), and the Children with Special Health Care Needs (CSHCN) Services Program for an additional dose for certain immunocompromised individuals. An additional dose of the COVID-19 vaccine has been recommended by the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices for individuals who are moderately to severely immunocompromised and should be administered at least 28 days after the second dose of the Pfizer-BioNTech or Moderna COVID-19 vaccine.

Procedure code 0003A is a benefit for individuals who are 12 years of age or older. Procedure code 0013A is a benefit for individuals who are 18 years of age or older.

Procedure codes 0003A and 0013A are Medicaid and HTW benefits for the following providers and places of service:

Place of Service

Provider Type

Office

Physician Assistant (PA), Nurse Practitioner (NP), Clinical Nurse Specialist (CNS), Physician, Pharmacist, Certified Nurse Midwife (CNM), Federally Qualified Healthcare Centers (FQHC), Nephrology (Hemodialysis, Renal Dialysis), Rural Health Clinics (RHC), Pharmacy

Home

PA, NP, CNS, Physician, Home Health Agency, CCP Provider

Outpatient Hospitals

FQHCs, Hospitals, Nephrology (Hemodialysis, Renal Dialysis), Renal Dialysis Facility, RHCs

Other Locations

PA, NP, CNS, Physician, FQHCs, CCP Provider, RHCs

Procedure codes 0003A and 0013A are CSHCN Services Program benefits for the following providers and places of service:

Place of Service

Provider Type

Office

PA, Advanced Practice Registered Nurse (APRN), Physician, Pharmacist, CCP Provider, Nephrology (Hemodialysis, Renal Dialysis), Pharmacy

Home

PA, APRN Physician, CCP Provider

Outpatient Hospitals

Nephrology (Hemodialysis, Renal Dialysis), Renal Dialysis Facility, Hospital Providers

Other Locations

PA, APRN, Physician, CCP Provider

Affected claims with dates of service on or after August 12, 2021, will be reprocessed, and providers may receive additional payment. Additional payments will be reflected on future Remittance and Status (R&S) Reports. Providers are not required to appeal the claims unless they are denied for additional reasons after the claims reprocessing is complete.

Providers interested in enrolling as a COVID-19 vaccinator should visit https://www.dshs.texas.gov/coronavirus/immunize/provider-information.aspx.

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