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COVID-19 Vaccine Administration Procedure Codes 0041A and 0042A Are Now Benefits

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This article has been updated. To view the updated information, click here.

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 July 13, 2022, in accordance with the U.S. Food and Drug Administration’s Emergency Use Authorization, COVID-19 vaccine administration codes 0041A and 0042A are benefits of Medicaid, Healthy Texas Women (HTW), the Family Planning Program (FPP), and the Children with Special Health Care Needs (CSHCN) Services Program for the administration of the first and second dose of the primary series of the Novavax COVID-19 vaccine to individuals 18 years of age and older.

Vaccine procedure code 91304 is informational only while the vaccine is distributed to providers free of charge.

Procedure codes 0041A and 0042A are Medicaid, HTW, and FPP benefits 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 0041A and 0042A are CSHCN Services Program benefits 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 July 13, 2022, procedure code M0201 (COVID-19 vaccine administration inside a patient’s home) can be billed in the home setting with procedure codes 0041A or 0042A for individuals 18 years of age and older.

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.