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Influenza Vaccine Procedure Code 90653 to Become a Benefit of Texas Medicaid Effective September 1, 2024

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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, 2024, influenza vaccine procedure code 90653 will become a benefit of Texas Medicaid for individuals 65 years of age or older.

Procedure code 90653 may be reimbursed for the following provider types and places of service:

Place of ServiceProvider Type
OfficePhysician, Physician Assistant, Nurse Practitioner, Clinical Nurse Specialist, Pharmacist, Certified Nurse Midwife, Registered Nurse, Licensed Midwife, Comprehensive Care Program (CCP), Nephrology (Hemodialysis, Renal Dialysis), Pharmacy
HomePhysician, CCP
Outpatient HospitalHospital, Nephrology (Hemodialysis, Renal Dialysis), Renal Dialysis Facility
Other LocationsPhysician, Physician Assistant, Nurse Practitioner, Clinical Nurse Specialist, CCP

Administration for procedure code 90653 may be reimbursed when billed with corresponding vaccine administration procedure code 90471 or 90472.

The Advisory Committee on Immunization Practices (ACIP) reviews the composition of influenza vaccines annually and frequently makes updates to their recommendations. Providers should refer to the Centers for Disease Control and Prevention (CDC) website for current recommendations.

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