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COVID-19 Vaccine Administration Procedure Codes 0121A, 0141A, 0142A, 0151A, 0171A, and 0172A Are Now Benefits

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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 April 18, 2023, in accordance with the U.S. Food and Drug Administration’s amended emergency use authorizations for the Pfizer-BioNTech and Moderna COVID-19 vaccines, vaccine administration procedure codes 0121A, 0141A, 0142A, 0151A, 0171A, and 0172A are benefits for Medicaid and the Children with Special Health Care Needs (CSHCN) Services Program.

The procedure codes are applicable for the following ages:

  • Procedure code 0121A is for the administration of the first dose of the bivalent Pfizer-BioNTech vaccine to individuals who are 12 years of age or older.
  • Procedure codes 0141A and 0142A are for the administration of the first and second dose of the bivalent Moderna vaccine to individuals who are 6 months through 11 years of age.
  • Procedure code 0151A is for the administration of the first dose of the bivalent Pfizer-BioNTech vaccine to individuals who are 5 years through 11 years of age.
  • Procedure codes 0171A and 0172A are for the administration of the first and second dose of the bivalent Pfizer-BioNTech vaccine to individuals who are 6 months through 4 years of age.

Vaccine procedure codes 91312, 91314, 91315, and 91317 will remain informational only while the vaccine is distributed to providers free of charge.

Note: The Family Planning Program and the Healthy Texas Women (HTW) Program will implement only procedure code 0121A. Procedure code 0121A is for individuals who are 12 years of age or older.

 

Medicaid Benefits

Procedure codes 0121A, 0141A, 0142A, 0151A, 0171A, and 0172A are Medicaid benefits for the following provider types and places of service:

Place of Service

Provider Type

Office

Physician, Physician Group, Physician Assistant, Nurse Practitioner, Clinical Nurse Specialist, Pharmacist, Pharmacy, Certified Nurse Midwife, Registered Nurse/Licensed Midwife, Federally Qualified Health Center, Comprehensive Care Program (CCP) Provider, Nephrology (Hemodialysis, Renal Dialysis), Rural Health Clinic (Freestanding/Independent and Hospital-based)

Home

Physician, Physician Group, Physician Assistant, Nurse Practitioner, Clinical Nurse Specialist, Home Health Agency, CCP Provider

Outpatient Hospital

Federally Qualified Health Center, Hospital, Nephrology (Hemodialysis, Renal Dialysis), Renal Dialysis Facility, Rural Health Clinic (Freestanding/Independent and Hospital-based)

Other Locations

Physician, Physician Group, Physician Assistant, Nurse Practitioner, Clinical Nurse Specialist, Federally Qualified Health Center, CCP Provider

Note: Federally qualified health centers (FQHCs) and rural health clinics (RHCs) may only be reimbursed separately for these COVID-19 vaccine administration procedure codes from April 18, 2023, to May 11, 2023.

CSHCN Services Program Benefits

Procedure codes 0121A, 0141A, 0142A, 0151A, 0171A, and 0172A are CSHCN Services Program benefits for the following provider types and places of service:

Place of Service

Provider Type

Office

Physician, Physician Assistant, Advanced Practice Registered Nurse, Pharmacist, Comprehensive Care Program (CCP) Provider, Nephrology (Hemodialysis, Renal Dialysis), Rural Health Clinic (RHC)

Home

Physician, Physician Assistant, Advanced Practice Registered Nurse, CCP Provider, Home Health Agency

Outpatient Hospital

Federally Qualified Health Center, Hospital, Nephrology (Hemodialysis, Renal Dialysis), Renal Dialysis Facility, Rural Health Clinic (Freestanding/Independent and Hospital-based)

Other Locations

Physician, Physician Group, Physician Assistant, Nurse Practitioner, Clinical Nurse Specialist, Federally Qualified Health Center, CCP Provider

As of April 18, 2023, procedure code M0201 (COVID-19 vaccine administration inside a patient’s home) may be billed in the home setting with procedure code 0121A, 0141A, 0142A, 0151A, 0171A, or 0172A.

Procedure code G0315 cannot be billed on the same day by the same provider as procedure code 0121A, 0141A, 0142A, 0151A, 0171A, or 0172A.

Claims submitted on dates of service from April 18, 2023, through June 5, 2023, with these procedure codes will be reprocessed. When the claims are reprocessed, providers may receive additional payment, which will be reflected on the Remittance and Status (R&S) Report.

Note: Procedure codes 0121A, 0141A, 0142A, 0151A, 0171A, and 0172A will be assigned interim rates until expenditures are approved, and permanent rates are adopted by Texas Medicaid. Providers will be notified of the permanent rates in a future article. Services provided before the interim rates are assigned will receive the following explanation of benefits (EOB) 02008 notification: “This procedure code has been approved as a benefit pending the approval of expenditures. Providers will be notified of the effective dates of service in a future notification if expenditures are approved.” Once expenditures are approved, TMHP will automatically reprocess the affected claims. Providers are not required to appeal the claims unless they are denied for other reasons after the claims reprocessing is complete.

Providers interested in enrolling as COVID-19 vaccinators should visit the Texas Department of State Health Services COVID-19 web page.

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