COVID-19 Vaccine and Vaccine Administration Procedure Codes 91318, 91319, 91320, 91321, 91322, and 90480 Are Now Benefits of Medicaid and CHIP

Starting from September 11, 2023, Medicaid and CHIP will cover the cost of the Pfizer-BioNTech and Moderna COVID-19 vaccines procedure codes 91318, 91319, 91320, 91321, 91322, as well as the vaccine administration procedure code 90480. This change comes in accordance with the U.S. Food and Drug Administration’s (FDA) amended emergency use authorizations. The procedure codes are applicable for the following ages:

Vaccine procedure codes 91318, 91319, 91320, 91321, and 91322, and vaccine administration procedure code 90480 are Medicaid and CHIP benefits that may be reimbursed for the following provider types and places of service:

Notes:

· Texas Health Steps Providers may be reimbursed for services rendered to Members who are 6 months through 20 years of age in the office, home, outpatient hospital, and other location settings.

· As of September 11, 2023, procedure code M0201 (COVID-19 vaccine administration inside a patient’s home) may be billed in the home setting with procedure code 90480.

· Immunization counseling is included in procedure code 90480. Procedure code G0315 cannot be billed on the same day by the same provider as procedure code 90480.

· Vaccines administered to individuals eligible for the Vaccines for Children (VFC) program should come from VFC-provided stocks. TMHP will process COVID-19 vaccine products submitted for reimbursement as informational only when administered to individuals 6 months through 18 years of age.

· As a reminder, Texas Medicaid and CHIP do not cover vaccines that are not authorized or approved by the FDA.

Additional Information:

HHSC will not cover procedure codes 91318, 91319, 91320, 91321, 91322, and 90480 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 had an end date of service of August 31, 2023.

Resources:

FDA Takes Action on Updated mRNA COVID-19 Vaccines to Better Protect Against Currently Circulating Variants | FDA

Next steps for Providers:

Providers should share this communication with their staff.

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