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Age Range Expansion for Pneumococcal 20-Valent Conjugate Vaccine Effective September 1, 2023

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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 September 1, 2023, the age range for procedure code 90677 was updated to individuals who are 2 months of age or older. Since this vaccine is distributed by the Texas Vaccines for Children (TVFC) Program, procedure code 90677 will process as informational-only when administered to individuals who are 2 months through 18 years of age.

Affected claims that are submitted with dates of service from September 1, 2023, through October 1, 2023, will be reprocessed. Providers may receive an additional payment, which will be reflected on future Remittance and Status Reports.

For more information, call the TMHP Contact Center at 800-925-9126.