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Reprocessing of Claims With Vaccine Procedure Code 90671

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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.

The Texas Medicaid & Healthcare Partnership (TMHP) has identified an issue with certain claims that were submitted with vaccine procedure code 90671 and with dates of service from September 1, 2022, through June 25, 2024. These claims may have been denied in error for the administration of the vaccine.

Affected claims with dates of service from September 1, 2022, through June 25, 2024, will be reprocessed, and providers may receive additional reimbursement, which will be reflected on future Remittance and Status (R&S) Reports.

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