Provider Alert! COVID-19 Vaccine Administration Procedure Codes 0081A, 0082A, 0083A, 0111A, 0112A, and 0113A Are Now Benefits of Texas Medicaid and CHIP
Date: August 8, 2022
Attention: All Providers
Effective Date: June 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: Texas Children’s Health Plan (TCHP) would like to inform providers that effective for dates of service on or after June 17, 2022, COVID-19 vaccine administration procedure codes 0081A, 0082A, 0083A, 0111A, 0112A, and 0113A are benefits of Texas Medicaid and CHIP.
The U.S. Food and Drug Administration (FDA) amended the Emergency Use Authorizations (EUA) for the Pfizer-BioNTech and Moderna COVID-19 vaccines. The following are the age requirements for these procedure codes:
- Procedure codes 0081A, 0082A, and 0083A are used to report the administration of the first, second, and third doses of the primary series of the Pfizer COVID-19 vaccine to children 6 months through 4 years of age.
- Procedure codes 0111A, 0112A, and 0113A are used to report the administration of the first and second doses of the primary series and the third dose of the Moderna COVID-19 vaccine to children 6 months through 5 years of age.
For more information, visit: https://www.cdc.gov/coronavirus/2019-ncov/vaccines/vaccines-children-teens.html
Vaccine procedure codes 91308 (Pfizer-BioNTech) and 91311 (Moderna) are informational only while the vaccine is distributed to providers free of charge.
Procedure codes 0081A, 0082A, 0083A, 0111A, 0112A, and 0113A are Medicaid and CHIP benefits for the following providers and places of service:
| Place of Service | Provider Type |
| Office | County Indigent Health Care Program, Physician, Physician Group, Physician Assistant, Nurse Practitioner, Clinical Nurse Specialist, Pharmacist, Pharmacy, Certified Nurse Midwife, Registered Nurse/Licensed Midwife, Federally Qualified Health Center, Comprehensive Care Program (CCP) Provider, Nephrology (Hemodialysis, Renal Dialysis), Rural Health Clinic (Freestanding/Independent and Hospital-based) |
| Home | Physician, Physician Groups, Physician Assistant, Nurse Practitioner, Clinical Nurse Specialist, Home Health Agency, Comprehensive Care Program (CCP) Provider |
| Outpatient Hospitals | Federally Qualified Health Center, Hospital, Nephrology (Hemodialysis, Renal Dialysis), Renal Dialysis Facility, Rural Health Clinic (Freestanding/Independent and Hospital-based) |
| Other Locations | County Indigent Health Care Program, Physician, Physician Group, Physician Assistant, Nurse Practitioner, Clinical Nurse Specialist, Federally Qualified Health Center, Comprehensive Care Program (CCP) Provider |
How this impacts providers:
Effective June 17, 2022, procedure code M0201 (COVID-19 vaccine administration inside a patient’s home) can be billed in the home setting with procedure codes 0081A, 0082A, 0083A, 0111A, 0112A, or 0113A for individuals 6 months through 4 and 5 years of age.
Providers are not required to appeal the claims unless they are denied for additional reasons after the claims reprocessing is complete. Providers may bill MCOs retroactively for COVID-19 vaccine administration codes 0081A, 0082A, 0083A, 0111A, 0112A, or 0113A for individuals 6 months through 4 and 5 years of age.
Providers in MCO networks interested in enrolling as a COVID-19 vaccinator should visit www.dshs.texas.gov/coronavirus/immunize/provider-information.aspx for more information.
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.
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