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Updated Age Range for COVID-19 Vaccine Administration Procedure Code M0201

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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.

Beginning February 10, 2022, for dates of service on or after October 29, 2021, COVID-19 vaccine administration add-on procedure code M0201 is a benefit for clients 5 years of age or older for Medicaid and the Children with Special Health Care Needs (CSHCN) Services Program.

Procedure code M0201 is an add-on procedure code for use when a COVID-19 vaccine is administered in the home setting, and it must be billed with one other COVID-19 vaccine administration code (0001A, 0002A, 0003A, 0004A, 0011A, 0012A, 0013A, 0031A, 0034A, 0051A, 0052A, 0053A, 0054A, 0064A, 0071A, 0072A, or 0073A).

Procedure code M0201 is a benefit for Medicaid and the CSHCN Services Program for the following place of service and provider types:

Place of Service

Provider Type

Home

Physician Assistant (PA), Nurse Practitioner (NP), Clinical Nurse Specialist (CNS), Physician, Clinic/Group Practice, Home Health Agency, Comprehensive Care Program (CCP) Provider

Any affected claims will be reprocessed. Providers are not required to appeal the claims unless the claims are denied for additional reasons after reprocessing is completed. TMHP has extended the 95-day claims filing deadline to 120 days from the date of service for claims submitted. This extension only applies to claims submitted for dates of service on or after October 29, 2021.

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 1-800-568-2413.