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COVID-19 Vaccine Administration Procedure Code 0074A Is Now a Benefit

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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 May 17, 2022, in accordance with the U.S. Food and Drug Administration (FDA) amendment to the Emergency Use Authorization (EUA), COVID-19 vaccine administration code 0074A is a benefit of Medicaid and the Children with Special Health Care Needs (CSHCN) Services Program for the administration of the booster dose of the Pfizer-BioNTech COVID-19 vaccine for individuals five years through 11 years of age.

Vaccine procedure code 91307 is informational only while the vaccine is distributed to providers free of charge.

Procedure code 0074A is a Medicaid benefit 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 Health Centers (FQHCs), Nephrology (Hemodialysis, Renal Dialysis), Rural Health Clinics (RHCs), Pharmacy

Home

PA, NP, CNS, Physician, Home Health Agency, Comprehensive Care Program (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 code 0074A is a CSHCN Services Program benefit for the following providers and places of service:

Place of Service

Provider Type

Office

PA, NP, CNS, Physician, Pharmacist, FQHCs, Nephrology (Hemodialysis, Renal Dialysis), RHCs, Pharmacy

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

As of May 17, 2022, procedure code M0201 (COVID-19 vaccine administration inside a patient’s home) can be billed in the home setting with procedure code 0074A.

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.