Provider Alert! COVID-19 Vaccine Administration Procedure Codes 0091A, 0092A, and 0093A Are Now Benefits for Medicaid and CHIP

Provider Alert! COVID-19 Vaccine Administration Procedure Codes 0091A, 0092A, and 0093A Are Now Benefits for 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, in accordance with the U.S. Food and Drug Administration (FDA) amendment to the Emergency Use Authorization (EUA), COVID-19 vaccine administration codes 0091A, 0092A, and 0093A are benefits for Medicaid and CHIP for the administration of the Moderna COVID-19 vaccine to individuals 6 through 11 years of age.

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

Procedure codes 0091A, 0092A, and 0093A are Medicaid and CHIP 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 (FQHCs), Nephrology (Hemodialysis, Renal Dialysis), Rural Health Clinics (RHCs), Pharmacy
Home PA, NP, CNS, Physician, Home Health Agency, Comprehensive Care Program (CCP) Provider
Outpatient Hospitals FQHCs, Hospitals, Nephrology (Hemodialysis, Renal Dialysis), Renal Dialysis Facility, RHCs
Other Locations PA, NP, CNS, Physician, FQHCs, CCP Provider, RHCs

 

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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