Provider Alert! COVID-19 Vaccine Administration Procedure Codes 0051A, 0052A, 0053A, and 0054A are Now BenefitsTexas Children's Health Plan
Date: June 7, 2022
Attention: All Providers
Effective date: Dates of service on or after 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.
Regarding system configuration updates, TCHP will apply updates and reprocess impacted claims as soon as possible. However, due to volume, please allow up to sixty (60) business days to complete. Providers are not required to appeal the claims unless they are denied for other reasons after the claims reprocessing is complete.
Providers should direct questions to their assigned Provider Relations Liaison or send an email inquiry to the Provider Relations Department at email@example.com.
Call to action: Effective for dates of service on or after January 3, 2022, COVID-19 vaccine administration codes 0051A, 0052A, 0053A, and 0054A are a benefit of Texas Medicaid and CHIP for the administration of the first, second, third (additional), and booster doses, respectively, of the tris-sucrose formulation of the Pfizer-BioNTech COVID-19 vaccine for individuals 12 years of age and older.
Vaccine procedure code 91305 is informational only while the vaccine is distributed to providers free of charge.
How this impacts providers: Procedure codes 0051A, 0052A, 0053A, and 0054A are benefits 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, Comprehensive Care Program (CCP) Provider|
|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 0051A, 0052A, 0053A, or 0054A for individuals 12 years of age and older, as of January 3, 2022.
Providers may bill MCOs retroactively for COVID-19 vaccine administration codes 0051A, 0052A, 0053A, and 0054A provided on or after January 3, 2022, for individuals 12 years of age and older. MCOs must reprocess affected claims submitted with the procedure code and date of service on or after January 3, 2022. 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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