Effective for dates of service on or after October 1, 2023, the respiratory syncytial virus (RSV) vaccine, procedure code 90678, is a benefit of Texas Medicaid and Texas Health Steps for pregnant individuals who are ten years of age or older and 32 through 36 weeks gestation.
As a reminder, procedure code 90678 may be reimbursed in Texas Medicaid for the following provider types and places of service:
In addition, Texas Health Steps medical providers may be reimbursed for services provided in the office, home, outpatient hospital, and other location settings.
Vaccines administered to individuals eligible for the Vaccines for Children (VFC) program should come from VFC-provided stocks. Vaccine products submitted for reimbursement will be processed as informational only when administered to individuals through 18 years of age. If the RSV vaccine is not available through VFC, providers may be reimbursed if the U1 modifier is submitted on the claim.
Next steps for Providers:
Providers should share this communication with their staff.
Community First Resources:
https://communityfirsthealthplans.com/provider-newsletter
https://communityfirsthealthplans.com/providers/
Contact:
Email ProviderRelations@cfhp.com or call 210-358-6294.