Community First Health Plans would like to inform providers of an important update to Texas Medicaid coverage for the respiratory syncytial virus (RSV) vaccine. Effective June 25, 2025, the age range limitations for RSV vaccine procedure codes 90679 and 90683 have been expanded to include Texas Medicaid members 50 years of age and older.
Providers should use administration code 90471 in conjunction with these vaccine procedure codes when submitting claims.
Key Details:
This update will be reflected in the November 2025 edition of the Texas Medicaid Provider Procedures Manual, Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook, in section 9.2.35.1, “Administration Fee,” and section 9.2.39, “Respiratory Syncytial Virus (RSV).”
MCOs are required to reprocess affected claims submitted with these procedure codes and with dates of service on or after June 25, 2025. Providers do not need to file appeals for these claims unless they are denied for additional reasons after reprocessing is complete. Providers may bill retroactively for procedure codes 90679 and 90683 for eligible members 50 years of age or older.
Providers are encouraged to share this information with their staff. If you have any questions about this notice, please email Provider Relations at ProviderRelations@cfhp.com or call 210-358-6030. You can also contact your Provider Relations Representative directly.
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