Provider Alert! Moderna COVID-19 Vaccine Administration Procedure Codes 0011A, 0012A, and 0013A Age Expansion for Medicaid and CHIP

Date: August 5, 2022

Attention: All Providers

Effective Dates: 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 0011A, 0012A, and 0013A are benefits of Medicaid and CHIP for the administration of the Moderna COVID-19 vaccine for individuals 12 years of age and older.

• Health and Human Services Commission (HHSC) will continue to cover procedure codes 0011A, 0012A, and 0013A as non-risk payments.
• Vaccine procedure code 91301 is informational only while the vaccine is distributed to providers free of charge.

How this impacts providers:

As of June 17, 2022, procedure code M0201 (COVID-19 vaccine administration inside a patient’s home) can be billed in the home setting with procedure code 0011A, 0012A, or 0013A for individuals 12 years of age and older.

Claims submitted with dates of service on or after June 17, 2022 will be automatically reprocessed by TCHP for appropriate payment to providers and providers may receive an additional payment. Providers do not need to submit appeals unless they are denied for other reasons after the claims reprocessing is complete.

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.