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COVID-19 Vaccine Administration Procedure Codes 0051A, 0052A, 0053A, and 0054A Are Now a Benefit

Last updated on 3/1/2022

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 January 3, 2022, COVID-19 vaccine administration codes 0051A, 0052A, 0053A, and 0054A are a benefit of Medicaid, Healthy Texas Women (HTW), the Family Planning Program (FPP), and the Children with Special Health Care Needs (CSHCN) Services Program for the administration of the first, second, third (additional), and booster doses, respectively, of the tris-sucrose formulation of the Pfizer-BioNTech COVID-19 vaccine for individuals 12 years of age and older.

Vaccine procedure code 91305 is informational only while the vaccine is distributed to providers free of charge.

Procedure codes 0051A, 0052A, 0053A, and 0054A are Medicaid, FPP, and HTW 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), Nephrology (Hemodialysis, Renal Dialysis), Rural Health Clinics (RHC), Pharmacy, Comprehensive Care Program (CCP) Provider

Home

PA, NP, CNS, Physician, Home Health Agency, CCP Provider

Outpatient Hospitals

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

Other Locations

PA, NP, CNS, Physician, FQHCs, CCP Provider, RHCs

Procedure codes 0051A, 0052A, 0053A, and 0054A 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, Pharmacist, CCP Provider, Nephrology (Hemodialysis, Renal Dialysis), Rural Health Clinics (RHC)

Home

PA, APRN, Physician, CCP Provider, Home Health Agency

Outpatient Hospitals

Nephrology (Hemodialysis, Renal Dialysis), Renal Dialysis Facility, Hospital Providers, Federally Qualified Healthcare Centers (FQHC), RHCs

Other Locations

PA, APRN, Physician, CCP Provider,
FQHCs, RHCs

Procedure code M0201 (COVID-19 vaccine administration inside a patient’s home) can be billed in the Home setting with procedure code 0051A, 0052A, 0053A, or 0054A for individuals 12 years of age and older, as of January 3, 2022.

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.