Effective for dates of service on or after April 18, 2023, in accordance with the U.S. Food and Drug Administration’s amended emergency use authorizations for the Pfizer-BioNTech and Moderna COVID-19 vaccines, vaccine administration procedure codes 0121A, 0141A, 0142A, 0151A, 0171A, and 0172A are benefits for Medicaid and CHIP.
The procedure codes are applicable for the following ages:
- Procedure code 0121A is for the administration of the first dose of the bivalent Pfizer-BioNTech vaccine to individuals who are 12 years of age or older.
- Procedure codes 0141A and 0142A are for the administration of the first and second dose of the bivalent Moderna vaccine to individuals who are 6 months through 11 years of age.
- Procedure code 0151A is for the administration of the first dose of the bivalent Pfizer-BioNTech vaccine to individuals who are 5 years through 11 years of age.
- Procedure codes 0171A and 0172A are for the administration of the first and second dose of the bivalent Pfizer-BioNTech vaccine to individuals who are 6 months through 4 years of age.
The Texas Health and Human Services Commission (HHSC) will cover procedure codes 0121A, 0141A, 0142A, 0151A, 0171A, and 0172A as non-risk payments. As referenced in the notice titled “Update on Reimbursement for Non-Risk Criteria for COVID-19 and CHIP Copay Waiver” published on June 8, 2023, the NRP COVID-19 reimbursement criteria will have an end date of service of August 31, 2023.
Vaccine procedure codes 91312, 91314, 91315, and 91317 will remain informational only while the vaccine is distributed to Providers free of charge.
Procedure codes 0121A, 0141A, 0142A, 0151A, 0171A, and 0172A are benefits of Medicaid and CHIP for the following Providers and places of service:
Federally qualified health centers (FQHCs) and rural health clinics (RHCs) may only be reimbursed separately for these COVID-19 vaccine administration procedure codes from April 18, 2023, to May 11, 2023.
As of April 18, 2023, procedure code M0201 (COVID-19 vaccine administration inside a patient’s home) may be billed in the home setting with procedure code 0121A, 0141A, 0142A, 0151A, 0171A, or 0172A.
Procedure code G0315 cannot be billed on the same day by the same Provider as procedure code 0121A, 0141A, 0142A, 0151A, 0171A, or 0172A.
Resources:
Interested in enrolling as a COVID-19 vaccinator? 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.
Community First Resources:
Contact:
Email ProviderRelations@cfhp.com or call 210-358-6294.