HHSC recently became aware of an issue causing some claims for the administration of the MenQuadfi vaccine (procedure code 90619) to be denied inappropriately.
MenQuadfi is approved by the U.S. Food and Drug Administration for individuals two years of age and older. This vaccine is distributed by the Texas Vaccines for Children (VFC) program for individuals 18 years of age or younger.
Procedure codes for vaccines distributed by VFC process as “Informational” on Texas Medicaid claims for individuals 18 years of age or younger but are reported along with the procedure code for administration of the vaccine, allowing the provider to be reimbursed for the administration service.
Procedure code 90619 is available for individuals two years of age and older. This update addresses an issue that caused some claims for procedure code 90619 for individuals 18 years of age or younger to be denied inappropriately. Claims for individuals 19 years of age or older were unaffected by this issue and no changes are required for these claims.
Community First must reprocess affected claims submitted with the procedure code and date of service on or after July 1, 2022. Providers are not required to appeal the claims unless they are denied for additional reasons after the claims reprocessing is complete.
For additional information, contact our Provider Relations division by phone at (210) 358-6294 or by email at ProviderRelations@CFHP.com.