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Some COVID-19 Vaccine Procedure Codes No Longer a Benefit of Texas Medicaid, CHIP, and HTW Effective October 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 October 1, 2024, some COVID-19 vaccine procedure codes will no longer be a benefit for Texas Medicaid, the Children’s Health Insurance Program (CHIP), and the Healthy Texas Women (HTW) program. These changes reflect the discontinued coverage of COVID-19 vaccines that do not have full approval by the U.S. Food and Drug Administration (FDA) by the end of the American Rescue Plan Act (ARPA) period.

The following COVID-19 vaccine procedure codes will no longer be a benefit:

Procedure Codes
91304913189131991321  

Note: Reimbursement rates for procedure codes 91304, 91318, 91319, and 91321 will be published in a public hearing to be made not a payable benefit. Once the rates are finalized, TMHP will automatically reprocess any affected claims. When the claims are reprocessed, providers may receive recoupments or reductions from future payments.

The following COVID-19 vaccine procedure codes will continue to be a benefit as they have full approval from the FDA:

Procedure Codes
9132091322    

Providers may still obtain all available vaccines recommended by the Advisory Committee on Immunization Practices for children (birth through 18 years of age) at no cost from the Texas Vaccines for Children (TVFC) Program. More information about the TVFC Program can be found at https://www.dshs.texas.gov/immunizations/providers/overview.

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