Effective for dates of service on or after June 17, 2022, COVID-19 vaccine administration procedure codes 0081A, 0082A, 0083A, 0111A, 0112A, and 0113A are benefits of Texas Medicaid and CHIP.
HHSC will cover procedure codes 0081A, 0082A, 0083A, 0111A, 0112A, and 0113A as non-risk payments.
AGE REQUIREMENTS
The U.S. Food and Drug Administration amended the Emergency Use Authorizations for the Pfizer-BioNTech and Moderna COVID-19 vaccines. The following are the age requirements for these procedure codes:
- Procedure codes 0081A, 0082A, and 0083A are used to report the administration of the first, second, and third doses of the primary series of the Pfizer COVID-19 vaccine to children 6 months through 4 years of age.
- Procedure codes 0111A, 0112A, and 0113A are used to report the administration of the first and second doses of the primary series and the third dose of the Moderna COVID-19 vaccine to children 6 months through 5 years of age.
For more information, visit COVID-19 Vaccines for Children and Teens.
Vaccine procedure codes 91308 (Pfizer-BioNTech) and 91311 (Moderna) are informational only while the vaccine is distributed to providers free of charge.
Benefits
Procedure codes 0081A, 0082A, 0083A, 0111A, 0112A, and 0113A are Medicaid and CHIP benefits for the following providers and places of service:
| PLACE OF SERVICE | PROVIDER TYPE |
|---|---|
| Office | County Indigent Health Care Program, Physician, Physician Group, Physician Assistant, Nurse Practitioner, Clinical Nurse Specialist, Pharmacist, Pharmacy, Certified Nurse Midwife, Registered Nurse/Licensed Midwife, Federally Qualified Health Center, Comprehensive Care Program (CCP) Provider, Nephrology (Hemodialysis, Renal Dialysis), Rural Health Clinic (Freestanding/Independent and Hospital-based) |
| Home | Physician, Physician Groups, Physician Assistant, Nurse Practitioner, Clinical Nurse Specialist, Home Health Agency, Comprehensive Care Program (CCP) Provider |
| Outpatient Hospital | Federally Qualified Health Center, Hospital, Nephrology (Hemodialysis, Renal Dialysis), Renal Dialysis Facility, Rural Health Clinic (Freestanding/Independent and Hospital-based) |
| Other Locations | County Indigent Health Care Program, Physician, Physician Group, Physician Assistant, Nurse Practitioner, Clinical Nurse Specialist, Federally Qualified Health Center, Comprehensive Care Program (CCP)Provider |
Effective June 17, 2022, procedure code M0201 (COVID-19 vaccine administration inside a patient’s home) can be billed in the home setting with procedure codes 0081A, 0082A, 0083A, 0111A, 0112A, or 0113A for individuals 6 months through 4 and 5 years of age.
RESOURCES:
CONTACT:
ProviderRelations@cfhp.com | (210) 358-6294