Skip to main content

Reimbursement Rate Updates for Influenza Vaccine (Procedure Code 90653) Effective September 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 September 1, 2024, reimbursement rate updates for the influenza vaccine (procedure code 90653) that were presented at the public rate hearing on December 4, 2024, will be implemented for Texas Medicaid and the Children with Special Health Care Needs (CSHCN) Services Program.

The Texas Medicaid & Healthcare Partnership (TMHP) will reprocess any affected claims that are identified. Providers are not required to appeal the claims unless the claims are denied for additional reasons after reprocessing is completed.

To view the updates, see the Influenza Vaccine Procedure Code 90653 spreadsheet.

For more information, call the TMHP Contact Center at 800-925-9126, or TMHP-CSHCN Services Program Contact Center at 800-568-2413.