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 June 17, 2022, in accordance with the Food and Drug Administration’s issuance of updated age restrictions for the emergency use authorization for the Moderna COVID-19 vaccine, coverage of vaccine administration procedure codes 0011A, 0012A, and 0013A are expanded for the following programs:
- Healthy Texas Women program
- Family Planning Program
- Children with Special Health Care Needs (CSHCN) Services Program
Vaccine administration procedure codes 0011A, 0012A, and 0013A have been expanded for individuals who are 12 years of age or older.
Vaccine procedure code 91301 is informational only while the vaccine is distributed to providers free of charge.
Procedure code M0201 (COVID-19 vaccine administration inside a patient’s home) can be billed in the home setting with procedure codes 0011A, 0012A, and 0013A.
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.