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Eligibility Changes for Pfizer-BioNTech and Moderna COVID-19 Vaccine Booster Doses

Last updated on 12/13/2021

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.

On November 19, 2021, the U.S. Food and Drug Administration (FDA) amended the emergency use authorizations (EUA) for both the Moderna and Pfizer-BioNTech COVID-19 vaccines, allowing use of a single booster dose for all individuals 18 years of age or older. On November 29, 2021, the Centers for Disease Control and Prevention (CDC) recommended that everyone age 18 or older should get a booster dose six months after their initial Pfizer-BioNTech or Moderna series or two months after their initial Janssen/Johnson & Johnson vaccine.

The booster dose of the Pfizer-BioNTech (procedure code 0004A) or Moderna (procedure code 0064A) COVID-19 vaccine should be administered at least six months after completion of the primary vaccination series. The booster dose of the Janssen/Johnson & Johnson (procedure code 0034A) COVID-19 vaccine should be administered at least two months after completion of the single-dose primary regimen.

As a reminder, a previous amendment to the FDA EUA for booster administration allows 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/media/releases/2021/s1129-booster-recommendations.html.

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.