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 March 29, 2022, reimbursement rates for COVID-19 administration procedure code 0094A (Moderna COVID-19 Vaccine (Blue Cap) 50MCG/0.5ML Administration – Booster) will be implemented for Texas Medicaid, Healthy Texas Women (HTW), Family Planning Program (FPP), and the Children with Special Health Care Needs (CSHCN) Services Program.
To view the updates, click the following link: COVID-19 Administration Procedure Code 0094A
Any affected claims that are identified will be reprocessed. Providers are not required to appeal the claims unless the claims are denied for additional reasons after reprocessing is completed.
For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.