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Update to Smallpox and Mpox Vaccine Reimbursement for the CSHCN Services Program

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Effective for dates of service on or after May 1, 2024, the smallpox and mpox vaccine (procedure code 90611) may be reimbursed for the following provider types and places of service for clients who are 18 years of age or older:

Place of ServiceProvider Type
OfficePhysicians, physician assistants, nurse practitioners, clinical nurse specialists
Outpatient hospitalHospital providers

Procedure code 90611 was previously processed as “informational only” because this vaccine was distributed by the federal government. Effective for dates of service on or after May 1, 2024, procedure code 90611 will be processed with a payable rate.

Claims that were submitted before August 1, 2024, with dates of service on or after May 1, 2024, will be reprocessed. Providers may receive additional payment when the claims are reprocessed.

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