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 November 3, 2022, for dates of service on or after October 12, 2022, the reimbursement rates for COVID-19 vaccine administration procedure codes 0144A (Moderna COVID-19 vaccine for ages 6-11 years) and 0154A (Pfizer-BioNTech COVID-19 vaccine for ages 5-11 years) will be implemented for Texas Medicaid and the Children with Special Health Care Needs (CSHCN) Services Program.
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.
To view the updates, click the following link: COVID-19 vaccine administration procedure codes 0144A and 0154A
For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.