Effective for dates of service on or after July 13, 2022, in accordance with the U.S. Food and Drug Administration’s Emergency Use Authorization, COVID-19 vaccine administration codes 0041A and 0042A are benefits of Medicaid and CHIP for the administration of the first and second dose of the primary series of the Novavax COVID-19 vaccine to individuals 18 years of age and older.
HHSC will cover procedure codes 0041A and 0042A as non-risk payments.
Vaccine procedure code 91304 is informational only while the vaccine is distributed to providers free of charge.
Procedure codes 0041A and 0042A are Medicaid and CHIP benefits for the following providers and places of service:
| PLACE OF SERVICE | PROVIDER TYPE |
|---|---|
| Office | Physician Assistant (PA), Nurse Practitioner (NP), Clinical Nurse Specialist (CNS), Physician, Pharmacist, Certified Nurse Midwife (CNM), Federally Qualified Healthcare Centers (FQHCs), Nephrology (Hemodialysis, Renal Dialysis), Rural Health Clinics (RHCs), Pharmacy |
| Home | PA, NP, CNS, Physician, Home Health Agency, Comprehensive Care Program (CCP) Provider |
| Outpatient Hospitals | FQHCs, Hospitals, Nephrology (Hemodialysis, Renal Dialysis), Renal Dialysis Facility, RHCs |
| Other Locations | PA, NP, CNS, Physician, FQHCs, CCP Provider, RHCs |
MCOs must reprocess affected claims submitted with these procedure codes and date of service on or after July 13, 2022. Providers are not required to appeal the claims unless they are denied for additional reasons after the claims reprocessing is complete. Providers may bill MCOs retroactively for COVID-19 vaccine administration codes 0041A and 0042A for individuals 18 years of age and older.
Providers in MCO networks interested in enrolling as a COVID-19 vaccinator should visit www.dshs.texas.gov/coronavirus/immunize/provider-information.aspx for more information.
RESOURCES:
Coronavirus (COVID-19) Update: FDA Authorizes Emergency Use of Novavax COVID-19 Vaccine, Adjuvanted
COVID-19 Vaccine Administration Procedure Codes 0041A and 0042A Are Now Benefits | TMHP
CONTACT:
ProviderRelations@cfhp.com | (210) 358-6294