Provider Alert! COVID-19 Vaccine Administration Procedure Codes 0074A and 0094A Are Now a Benefit of Medicaid and CHIP

Date: July 8, 2022

Attention: All Providers

Effective Dates: 

• Procedure Code 0094A on or after March 29, 2022
• Procedure Code 0074A on or after May 17, 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:

For procedure code 0094A, Texas Children’s Health Plan (TCHP) would like to inform providers that effective for dates of service on or after March 29, 2022, in accordance with the U.S. Food and Drug Administration (FDA) amendment to the Emergency Use Authorization (EUA), COVID-19 vaccine administration code 0094A is a benefit or Medicaid and CHIP for the administration of the booster dose of the Moderna COVID-19 vaccine to individuals 18 years of age and older.

• Vaccine procedure code 91309 is informational only while the vaccine is distributed to providers free of charge.

For procedure code 0074A, TCHP would like to inform providers that effective for dates of service on or after May 17, 2022, in accordance with the FDA amendment to the EUA, COVID-19 vaccine administration code 0074A is a benefit of Medicaid and CHIP for the administration of the booster dose of the Pfizer-BioNTech COVID-19 vaccine for individuals five through 11 years of age.

• Vaccine procedure code 91307 is informational only while the vaccine is distributed to providers free of charge.

Procedure codes 0094A and 0074A are benefits for the following providers and places of service:

How this impacts providers:

As of March 29, 2022, procedure code M0201 (COVID-19 vaccine administration inside a patient’s home) can be billed in the home setting with procedure code 0094A.

As of May 17, 2022, procedure code M0201 can be billed in the home setting with procedure code 0074A.

Next steps for providers: Providers should share this communication with their staff.

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.