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Reimbursement Rate Updates for RSV Vaccine Procedure Code 90678 Effective October 1, 2023, for Texas Health Steps

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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 October 1, 2023, reimbursement rate updates for respiratory syncytial virus (RSV) vaccine procedure code 90678 will be implemented for Texas Health Steps.

The Texas Medicaid & Healthcare Partnership (TMHP) will reprocess any affected claims that are identified. Providers are not required to appeal the claims unless they are denied for additional reasons after reprocessing is completed.

Updates are available at Respiratory Syncytial Virus (RSV) Vaccine Procedure Code 90678.

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