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 August 19, 2021, for dates of service on or after August 12, 2021, the reimbursement rates for COVID-19 vaccine administration procedure codes 0003A (Immunization administration by intramuscular injection for COVID-19 vaccine third dose (Pfizer-BioNTech) and 0013A (Immunization administration by intramuscular injection for COVID-19 vaccine third dose (Moderna) will be updated for Texas Medicaid, the Children with Special Health Care Needs (CSHCN) Services Program, Healthy Texas Women (HTW), and the Family Planning Program.
To view the updates, click the following link: COVID-19 Vaccine Administration Codes 0003A and 0013A
Affected claims, if any are identified, will be reprocessed. Providers are not required to appeal the claims unless they are denied for additional reasons after the claims reprocessing is completed.
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.