Skip to main content

Reimbursement Rate Updates for RSV Vaccines Procedure Codes 90678 and 90679 Effective October 1, 2023

Last updated on

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 October 1, 2023, reimbursement rate updates for respiratory syncytial virus (RSV) vaccine procedure codes 90678 and 90679 will be implemented for Texas Medicaid.

The Texas Medicaid & Healthcare Partnership (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.

Updates are available at Respiratory Syncytial Virus (RSV) Vaccines.

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