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COVID-19 Vaccine Administration Procedure Codes 0034A and 0064A are Benefits

Last updated on 11/15/2021

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 October 20, 2021, in accordance with the U.S. Food and Drug Administration (FDA) amendments to the Emergency Use Authorizations (EUAs), COVID-19 vaccine administration procedure codes 0034A and 0064A are benefits of Medicaid, Healthy Texas Women (HTW), the Family Planning Program (FPP), and the Children with Special Health Care Needs (CSHCN) Services Program.

The FDA amendments to the EUAs allow the following:

  • The use of a single booster dose of the Janssen COVID-19 vaccine (procedure code 0034A), at least two months after completion of the single-dose primary regimen to individuals who are 18 years of age or older
  • The use of a single booster dose of the Moderna COVID-19 vaccine (procedure code 0064A), at least six months after completion of the primary series in:
    • Individuals who are 65 years of age or older
    • Long-term care facility residents who are 18 years of age or older.
    • Individuals who are 18 through 64 years of age with underlying medical conditions
    • Individuals who are 18 through 64 years of age and at increased risk for exposure and transmission due to occupational or institutional setting
      Note: Moderna COVID-19 vaccine procedure code 91306 is processed as informational only.
  • The use of any of the available COVID-19 vaccines as a heterologous (“mix-and-match”) booster dose in eligible individuals after completion of the primary vaccination with a different COVID-19 vaccine

For more information, visit https://dshs.texas.gov/covidvaccine/ or https://www.cdc.gov/coronavirus/2019-ncov/vaccines/booster-shot.html.

Procedure codes 0034A and 0064A are Medicaid, HTW, and FPP 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), Comprehensive Care Program (CCP) provider, nephrology (hemodialysis, renal dialysis), rural health clinic (RHC), and pharmacy providers

Home

PA, NP, CNS, physician, home health agency, and CCP providers

Outpatient hospital

FQHC, hospital, nephrology (hemodialysis, renal dialysis), renal dialysis facility, and RHC providers

Other location

PA, NP, CNS, physician, FQHC, CCP provider, and RHC providers

Procedure codes 0034A and 0064A are CSHCN Services Program benefits for the following providers and places of service:

Place of Service

Provider Type

Office

Advanced practice registered nurse (APRN), physician, pharmacist, FQHC, CCP provider, nephrology (hemodialysis, renal dialysis), RHC, and pharmacy providers

Home

APRN, physician, home health agency, and CCP providers

Outpatient hospital

FQHC, hospital, nephrology (hemodialysis, renal dialysis), renal dialysis facility, and RHC providers

Other location

APRN, physician, FQHC, CCP provider, and RHC providers

Procedure code M0201 (COVID-19 vaccine administration inside a patient’s home) can be billed in the home setting with procedure code 0034A or 0064A as of October 20, 2021.

Affected claims with dates of service on or after October 20, 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.