Key Details:

Effective for dates of service on or after December 8, 2022, in accordance with the U.S. Food and Drug Administration’s amended Emergency Use Authorizations, COVID-19 vaccine administration codes 0164A (Moderna) and 0173A (Pfizer-BioNTech) are now benefits of Medicaid and CHIP for administration of the following:

–      Moderna COVID-19 bivalent booster vaccine to individuals 6 months through 5 years of age

–      Pfizer-BioNTech COVID-19 bivalent booster vaccine to individuals 6 months through 4 years of age

The Texas Health and Human Services Commission (HHSC) will cover procedure codes 0164A and 0173A as non-risk payments.

Vaccine procedure codes 91316 (Moderna) and 91317 (Pfizer-BioNTech) are informational only while the vaccine is distributed to providers free of charge.

Procedure codes 0164A and 0173A are benefits of Medicaid and CHIP for the following providers and places of service:

As of December 8, 2022, procedure code M0201 (COVID-19 vaccine administration inside a patient’s home) can be billed in the home setting with procedure codes 0164A or 0173A for individuals 6 months through 5 years of age or 6 months through 4 years of age, respectively.

Providers may bill MCOs retroactively for COVID-19 vaccine administration codes 0164A or 0173A for individuals 6 months through 5 years of age or 6 months through 4 years of age, respectively.

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.

Next steps for providers: Providers should share this communication with their staff.

Resources:

Coronavirus (COVID-19) Update: FDA Authorizes Updated (Bivalent) COVID-19 Vaccines for Children Down to 6 Months of Age | FDA

Contact:

Email ProviderRelations@cfhp.com or call 210-358-6294.

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