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Reimbursement Rate Updates for COVID-19 Vaccine Consultation Procedure Code G0315 Effective December 2, 2021

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Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to Medicaid members who are enrolled in their MCO. Administrative procedures, such as prior authorization, precertification, referrals, and claims and encounter data filing, may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should contact the member’s specific MCO for details.

Effective for dates of service on or after December 2, 2021, the Texas Medicaid & Healthcare Partnership (TMHP) will implement the reimbursement rates for COVID-19 vaccine consultation procedure code G0315 for Texas Medicaid and the Children with Special Health Care Needs (CSHCN) Services Program.

TMHP will reprocess any affected claims that are identified. Providers are not required to appeal the claims unless the claims are denied for additional reasons after reprocessing is completed.

To get the updates, access the following: COVID-19 Vaccine Consultation Procedure Code G0315

For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.