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COVID-19 Vaccine Administration Procedure Codes 0091A, 0092A, and 0093A Are Now Benefits

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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 June 17, 2022, in accordance with the U.S. Food and Drug Administration amendment to the Emergency Use Authorization, COVID-19 vaccine administration codes 0091A, 0092A, and 0093A are benefits of Medicaid and the Children with Special Health Care Needs (CSHCN) Services Program for the administration of the Moderna COVID-19 vaccine to individuals 6 through 11 years of age.

Vaccine procedure code 91309 is informational only while the vaccine is distributed to providers free of charge.

Procedure codes 0091A, 0092A, and 0093A are 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 Healthcare 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 codes 0091A, 0092A, and 0093A are 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 June 17, 2022, procedure code M0201 (COVID-19 vaccine administration inside a patient’s home) can be billed in the home setting with procedure codes 0091A, 0092A, or 0093A for individuals 6 through 11 years of age.

Affected claims with dates of service on or after June 17, 2022, will be reprocessed. Providers may receive an additional payment, which would be reflected on future Remittance and Status Reports. Providers are not required to appeal the claims unless the claims are denied for additional reasons after the reprocessing is complete.

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.