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.
Starting October 7, 2021, for dates of service on or after September 22, 2021, the reimbursement rates for COVID-19 vaccine administration procedure code 0004A were implemented for Texas Medicaid, the Children with Special Health Care Needs (CSHCN) Services Program, Healthy Texas Women (HTW), and the Family Planning Program (FPP).
To view the updates, click the following link: COVID-19 Vaccine Administration Procedure Code 0004A
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 800-568-2413.