Provider Alert! COVID-19 Vaccine Administration Code 0004A UpdateTexas Children's Health Plan
Date: January 20, 2022
Attention: Primary Care Providers
Effective Date: January 3, 2022
Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to the COVID-19 event. TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event.
Call to action: Effective January 3, 2022, the U.S. Food and Drug Administration (FDA) amended the Emergency Use Authorization (EUA), for the Pfizer-BioNTech COVID-19 vaccine administration code 0004Ato include:
- Authorization of a booster dose for people 12 years and older.
- A shortened time interval of 5 months between a booster dose and completion of the primary vaccine series for people 12 years and older.
- A third primary series dose is allowed for certain immunocompromised children 5 to 11 years.
How this impacts providers: Procedure code 0004A is a benefit for Medicaid for the following providers and places of service:
|Place of Service||Provider Type|
|Office||Physician Assistant (PA), Nurse Practitioner (NP), Clinical Nurse Specialist (CNS), Physician, Pharmacist, Certified Nurse Midwife (CNM), Federally Qualified Healthcare Centers (FQHC), Nephrology (Hemodialysis, Renal Dialysis), Rural Health Clinics (RHC), Pharmacy|
|Home||PA, NP, CNS, Physician, Home Health Agency, CCP Provider|
|Outpatient Hospitals||FQHCs, Hospitals, Nephrology (Hemodialysis, Renal Dialysis), Renal Dialysis Facility, RHCs|
|Other Locations||PA, NP, CNS, Physician, FQHCs, CCP Provider, RHCs|
Procedure code M0201 (COVID-19 vaccine administration inside a patient’s home) can be billed in the Home setting with procedure code 0004A, as of September 22, 2021.
Providers may bill MCOs retroactively for COVID-19 vaccine administration code 0004A provided on or after September 22, 2021. MCOs will reprocess affected claims submitted with the procedure code and date of service on or after September 22, 2021. Providers are not required to appeal the claims unless they are denied for additional reasons after the claims reprocessing is complete.
Next steps for providers: Providers should share this communication with their staff.
Providers interested in enrolling as a COVID-19 vaccinator should visit www.dshs.texas.gov/coronavirus/immunize/provider-information.aspx for more information.
If you have any questions, please email Provider Network Management at: firstname.lastname@example.org.
For access to all provider alerts, log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.
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