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COVID-19 Vaccine Administration Procedure Codes 0081A, 0082A, 0083A, 0111A, 0112A, and 0113A Are Now Benefits for Medicaid and CSHCN

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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, COVID-19 vaccine administration procedure codes 0081A, 0082A, 0083A, 0111A, 0112A, and 0113A are benefits of Texas Medicaid and the Children with Special Health Care Needs (CSHCN) Services Program.

Age Requirements

The U.S. Food and Drug Administration amended the Emergency Use Authorizations for the Pfizer-BioNTech and Moderna COVID-19 vaccines. The following are the age requirements for these procedure codes:

  • Procedure codes 0081A, 0082A, and 0083A are used to report the administration of the first, second, and third doses of the primary series of the Pfizer COVID-19 vaccine to children 6 months through 4 years of age.
  • Procedure codes 0111A, 0112A, and 0113A are used to report the administration of the first and second doses of the primary series and the third dose of the Moderna COVID-19 vaccine to children 6 months through 5 years of age.

Vaccine procedure codes 91308 (Pfizer-BioNTech) and 91311 (Moderna) are informational only while the vaccine is distributed to providers free of charge.

For more information, visit https://www.cdc.gov/coronavirus/2019-ncov/vaccines/vaccines-children-teens.html.

Benefits

Procedure codes 0081A, 0082A, 0083A, 0111A, 0112A, and 0113A are Medicaid benefits for the following providers and places of service:

Medicaid

Place of Service

Provider Type

Office

County Indigent Health Care Program, Physician, Physician Group, Physician Assistant, Nurse Practitioner, Clinical Nurse Specialist, Pharmacist, Pharmacy, Certified Nurse Midwife, Registered Nurse/Licensed Midwife, Federally Qualified Health Center, Comprehensive Care Program (CCP) Provider, Nephrology (Hemodialysis, Renal Dialysis), Rural Health Clinic (Freestanding/Independent and Hospital-based)

Home

Physician, Physician Groups, Physician Assistant, Nurse Practitioner, Clinical Nurse Specialist, Home Health Agency, Comprehensive Care Program (CCP) Provider

Outpatient Hospital

Federally Qualified Health Center, Hospital, Nephrology (Hemodialysis, Renal Dialysis), Renal Dialysis Facility, Rural Health Clinic (Freestanding/Independent and Hospital-based)

Other Locations

County Indigent Health Care Program, Physician, Physician Group, Physician Assistant, Nurse Practitioner, Clinical Nurse Specialist, Federally Qualified Health Center, Comprehensive Care Program (CCP) Provider

CSHCN Services Program

Procedure codes 0081A, 0082A, 0083A, 0111A, 0112A, and 0113A are CSHCN Services Program benefits for the following providers and places of service:

Place of Service

Provider Type

Office

Physician, Physician Assistant, Advanced Practice Registered Nurse, Pharmacist, Comprehensive Care Program (CCP) Provider, Nephrology (Hemodialysis, Renal Dialysis), Rural Health Clinic (RHC)

Home

Physician, Physician Assistant, Advanced Practice Registered Nurse, Comprehensive Care Program (CCP) Provider, Comprehensive Care Program (CCP) Provider, Home Health Agency

Outpatient Hospitals

Nephrology (Hemodialysis, Renal Dialysis), Renal Dialysis Facility, Hospital Provider, Federally Qualified Healthcare Center (FQHC), Rural Health Clinic (RHC)

Other Locations

Physician, Physician Assistant, Advanced Practice Registered Nurse, Comprehensive Care Program (CCP) Provider, Federally Qualified Healthcare Center (FQHC), Rural Health Clinic (RHC)

Effective 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 0081A, 0082A, 0083A, 0111A, 0112A, or 0113A for individuals 6 months through 4 and 5 years of age.

Affected claims with dates of service on or after June 17, 2022, will be reprocessed, and providers may receive additional payment. Additional payments will be reflected on future Remittance and Status (R&S) Reports. Providers are not required to appeal the claims unless they are denied for additional reasons after the claims 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 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.