Skip to main content

Updates to Vaccine Administration Procedure Code M0201

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 January 1, 2024, vaccine administration add-on procedure code M0201 may be billed in the home setting for Texas Medicaid with the following procedure codes:

Procedure Codes
90630906369065490655906569065790658
90660906619066290670906719067290673
90674906779068290685906869068790688
90694906979072390732907399074090743
9074490746907479075690759  

Effective January 1, 2024, vaccine administration add-on procedure code M0201 may be billed in the home setting for the Children with Special Health Care Needs (CSHCN) Services Program with the following procedure codes:

Procedure Codes
90630906369065490655906569065790658
90660906619066290670906729067390674
90682906859068690687906889072390732
90739907409074390744907469074790756
90759      

M0201 will be payable as an add-on code if billed with any of these vaccines, along with the existing COVID-19 vaccine administration procedure code, if administered inside a client’s home.

The Texas Medicaid & Healthcare Partnership (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. When the claims are reprocessed, providers may receive additional payment, which will be reflected on the Remittance and Status (R&S) Report.

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