Provider Alert! Updated Age Range for COVID-19 Vaccine Administration Procedure Code M0201

Date: May 4, 2022

Attention: All Providers

Effective date: Dates of service on or after October 29, 2021

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.

TCHP will apply updates and reprocess impacted claims as soon as possible. However, please allow up to sixty (60) business days for reprocessing. Providers are not required to appeal claims unless denied for other reasons.

Providers should direct questions to their Provider Relations Liaison or send an email inquiry to the Provider Relations Department at providerrelations@texaschildrens.org.

Call to action: Effective for dates of service on or after October 29, 2021, COVID-19 vaccine administration add-on procedure code M0201 is a benefit for clients 5 years of age or older for Texas Medicaid and CHIP.

How this impacts providers: Procedure code M0201 is an add-on procedure code for use when a COVID-19 vaccine is administered in the home setting, and it must be billed with one other COVID-19 vaccine administration code (0001A, 0002A, 0003A, 0004A, 0011A, 0012A, 0013A, 0031A, 0034A, 0051A, 0052A, 0053A, 0054A, 0064A, 0071A, 0072A, or 0073A).
Procedure code M0201 is a benefit for the following providers and places of service:

TCHP will reprocess affected claims submitted with the M0201 Procedure Code and date of service on or after October 29, 2021. Providers are not required to appeal the claims unless they are denied for other reasons after the claims reprocessing is complete. Providers may bill TCHP retroactively for COVID-19 vaccine administration code M0201 for individuals 5 years of age and older. TCHP will waive the 95-day filing deadline for any claims that were not submitted prior to this notification.

Next steps for providers: Providers should share this information 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: providerrelations@texaschildrens.org.

For access to all provider alerts, log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.