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.
This is an update to the article titled ”COVID-19 Vaccine Administration Procedure Codes 0041A and 0042A Are Now Benefits” that was published on August 3, 2022.
Effective for dates of service on or after August 19, 2022, the age range for COVID-19 vaccine administration codes 0041A and 0042A has changed from 18 years of age or older to 12 years of age or older.
These procedure codes are benefits of Medicaid, Healthy Texas Women, the Family Planning Program, and the Children with Special Health Care Needs Services Program for the administration of the first and second dose of the primary series of the Novavax COVID-19 vaccine for individuals 12 years of age or older.
Affected claims submitted for clients 12 years of age or older with dates of service from August 19, 2022, through August 29, 2022, and procedure code 0041A or 0042A will be reprocessed. When the claims are reprocessed, providers may receive additional payment, which will be reflected on Remittance and Status Reports.
Vaccine procedure code 91304 is informational only while the vaccine is distributed to providers free of charge.
As of August 19, 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 12 years of age or older.
Providers interested in enrolling as a COVID-19 vaccinator should visit 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.