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Pediatric COVID-19 Vaccine Administration Codes 0071A and 0072A Are Now Benefits

Last updated on 11/18/2021

Effective for dates of service on or after October 29, 2021, in accordance with the U.S. Food and Drug Administration (FDA) Emergency Use Authorization (EUA) for the Pfizer-BioNTech COVID-19 vaccine, vaccine administration procedure codes 0071A and 0072A are benefits of Medicaid and the Children with Special Health Care Needs (CSHCN) Services Program for individuals 5 through 11 years of age. Vaccine procedure code 91307 is informational only while the vaccine is distributed to providers free of charge.

Procedure codes 0071A and 0072A are benefits for Medicaid 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, Clinic/Group Practice, Pharmacist, Certified Nurse Midwife (CNM), FQHC, Comprehensive Care Program (CCP) Provider, Nephrology (Hemodialysis, Renal Dialysis), RHCs, Pharmacy

Home

PA, NP, CNS, Physician, Clinic/Group Practice, Home Health Agency, CCP Provider

Outpatient Hospital

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

Other Locations

PA, NP, CNS, Physician, Clinic/Group Practice, FQHC, CCP Provider, RHCs

Procedure codes 0071A and 0072A are a CSHCN Services Program benefit for the following providers and places of service:

Place of Service

Provider Type

Office

PA, Advanced Practice Registered Nurse (APRN), Physician, Clinic/Group Practice, FQHC, CCP Provider, Nephrology (Hemodialysis, Renal Dialysis), RHCs

Home

PA, APRN, Physician, Clinic/Group Practice, Home Health Agency, CCP Provider

Outpatient Hospital

FQHC, Hospitals, Nephrology (Hemodialysis, Renal Dialysis), Renal Dialysis Facility, RHC

Other Locations

PA, APRN, Physician, Clinic/Group Practice, FQHC, CCP Provider, RHC

Providers should reference the table below when submitting claims for COVID-19 vaccine administration for individuals 5 through 11 years of age:

Vaccine Code

Vaccine Administration Codes

Labeler Name

Administration Interval

91307

0071A (first dose)

Pfizer

21 days

0072A (second dose)

Procedure code M0201 (COVID-19 vaccine administration inside a patient’s home) can be billed in the Home setting with procedure code 0071A or 0072A as of October 29, 2021.

Affected claims with dates of service on or after October 29, 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.