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Updates to Age Restriction for Procedure Code 90619

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The Texas Medicaid & Healthcare Partnership (TMHP) has identified an issue that affects claims submitted with procedure code 90619 for dates of service from July 1, 2020, through May 31, 2022, for Medicaid clients 18 years of age or younger.

Procedure codes for vaccines distributed by the Texas Vaccines for Children program are processed as “Informational” on Texas Medicaid claims for individuals 18 years of age or younger but are reported along with the procedure code for administration of the vaccine, allowing the provider to be reimbursed for the administration service.

Procedure code 90619 is available for individuals two years of age and older. This update addresses an issue that caused some claims for procedure code 90619 for individuals 18 years of age or younger to be denied inappropriately. Claims for individuals 19 years of age or older were unaffected by this issue, and no changes are required for these claims.

Affected claims that were submitted with dates of service from July 1, 2020, through May 31, 2022, will be reprocessed. Reprocessing may result in an additional payment that will be reflected on future Remittance and Status (R&S) reports.

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