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Age Range Updates for RSV Vaccine Procedure Codes Effective June 25, 2025

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Texas Medicaid has updated the age range limitations for the respiratory syncytial virus (RSV) vaccine (procedure codes 90679 and 90683) to 50 years of age or older.

This update is effective for all dates of service on or after June 25, 2025.

The Texas Medicaid & Healthcare Partnership (TMHP) will update the age range limitation in the November 2025 edition of the Texas Medicaid Provider Procedures Manual, Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook, section 9.2.35.1, “Administration Fee,” and section 9.2.39, “Respiratory Syncytial Virus (RSV).”

Claims Reprocessing

TMHP will identify and reprocess any claims that have been affected by this update. If there are any adjustments to claims reimbursement amounts, they will appear on future Remittance and Status (R&S) Reports.

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

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.