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Reimbursement for COVID-19 Vaccines Ended May 12, 2023, for FQHCs and RHCs

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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 May 12, 2023, claims submitted by federally qualified health centers (FQHCs) and rural health clinics (RHCs) for the administration of COVID-19 vaccines will no longer be reimbursed. The Texas Health and Human Services Commission (HHSC) has directed the Texas Medicaid & Healthcare Partnership (TMHP) to stop payments due to the end of the public health emergency (PHE).

The table below lists the COVID-19 vaccine administration procedure codes that will not be reimbursed to FQHCs and RHCs for dates of service on or after May 12, 2023. However, claims with the procedure codes listed in the table below that were submitted by FQHCs and RHCs from May 12, 2023, through May 30, 2023, may be reprocessed. Affected claims may result in recoupment, which will be reflected on future Remittance and Status (R&S) Reports.

 

Procedure Codes

0001A

0002A

0003A

0004A

0011A

0012A

0013A

0031A

0034A

0041A

0042A

0044A

0051A

0052A

0053A

0054A

0064A

0071A

0072A

0073A

0074A

0081A

0082A

0083A

0091A

0092A

0093A

0094A

0111A

0112A

0113A

0124A

0134A

0144A

0154A

0164A

0173A

0174A

D1701

D1702

D1703

D1704

D1707

D1708

D1709

D1710

D1711

D1712

D1713

D1714

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