Provider Alert! COVID-19 Vaccine Administration Procedure Codes 0041A and 0042A Are Now Benefits for Medicaid/CHIP
Date: August 17, 2022
Attention: All Providers
Effective Date: July 13, 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 July 13, 2022, in accordance with the U.S. Food and Drug Administration (FDA)’s Emergency Use Authorization (EUA), COVID-19 vaccine administration codes 0041A and 0042A are benefits of Medicaid and CHIP. The procedure codes are for the administration of the first and second dose of the primary series of the Novavax COVID-19 vaccine to individuals 18 years of age and older.
Vaccine procedure code 91304 is informational only while the vaccine is distributed to providers free of charge.
Procedure codes 0041A and 0042A 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 July 13, 2022, procedure code M0201 (COVID-19 vaccine administration inside a patient’s home) can be billed in the home setting with procedure codes 0041A and 0042A for individuals 18 years of age and older.
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.
Resources:
- https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-authorizes-emergency-use-novavax-covid-19-vaccine-adjuvanted
- COVID-19 Vaccine Administration Procedure Codes 0041A and 0042A Are Now Benefits | TMHP
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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