Skip to main content

RSV Vaccine Procedure Code 90683 a Benefit of Texas Medicaid Effective October 1, 2024

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 for dates of service on or after October 1, 2024, respiratory syncytial virus (RSV) vaccine procedure code 90683 will become a benefit of Texas Medicaid for individuals who are 60 years of age or older.

Procedure code 90683 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), Pharmacy
HomePhysician, Physician Assistant, Nurse Practitioner, Clinical Nurse Specialist, CCP
Outpatient HospitalHospital Providers
Other LocationsPhysician, Physician Assistant, Nurse Practitioner, Clinical Nurse Specialist, CCP

Administration of procedure code 90683 may be reimbursed when billed with corresponding vaccine administration procedure code 90471 or 90472. 

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