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June 2026 TMPPM Update for Vaccine Services Procedure Code 90461

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On June 1, 2026, the Texas Medicaid & Healthcare Partnership (TMHP) will update the Texas Medicaid Provider Procedures Manual (TMPPM) to clarify that providers should use vaccine services procedure code 90461 to report the administration of additional components of a vaccine. Texas Medicaid will not reimburse claims for procedure code 90461 to providers when they administer vaccines that are eligible under the Texas Vaccines for Children (TVFC) programs.

The following TMPPM handbooks will be updated with clarifying language:

  • Children’s Services Handbook, section 4.5.4, “Vaccine Reimbursement,” in the “Administration With Counseling” subsection
  • Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook, section 9.2.35.1, “Administration Fee”

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.