Skip to main content

Reimbursement Rate Updates Implemented for COVID-19 Vaccine Administration Procedure Codes

Last updated on

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.

Beginning August 25, 2022, for dates of service between March 11, 2021, and March 14, 2021, and for dates of service on or after March 15, 2021, the reimbursement rates for COVID-19 vaccine administration procedure codes for dental providers will be implemented for Texas Medicaid and the Children with Special Health Care Needs (CSHCN) Services Program.

Effective for Dates of Service Between March 11, 2021, and March 14, 2021

Refer to the COVID-19 vaccine administration procedure codes.

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.

Effective for Dates of Service on or After March 15, 2021

Refer to COVID-19 vaccine administration procedure codes.

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.