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Pneumococcal Vaccine Procedure Codes 90671 and 90677 to Become Benefits of Texas Medicaid March 1, 2022

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Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to eligible clients. Administrative procedures such as prior authorization, precertification, 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 March 1, 2022, pneumococcal vaccine procedure codes 90671 and 90677 will become benefits of Texas Medicaid for clients who are 18 years of age or older as follows:

Place of Service

When Services Are Provided by

Office

Physician assistant (PA), nurse practitioner (NP), clinical nurse specialist (CNS), physician, pharmacy, pharmacist, certified nurse midwife, registered nurse, federally qualified health center (FQHC), Texas Health Steps (THSteps) medical, and Comprehensive Care Program (CCP) providers

Home

PA, NP, CNS, physician, FQHC, THSteps medical, and CCP providers

Outpatient hospital

FQHC, hospital, and THSteps medical providers

Other location

PA, NP, CNS, physician, FQHC, THSteps medical, and CCP providers

Note: All new and updated procedure codes and their associated reimbursement rates are proposed benefits, pending the January 2022 rate hearing and approval of expenditures. Providers will be notified when the rates and expenditures are approved.

For more information, call the TMHP Contact Center at 800-925-9126.