Provider Alert! COVID-19 Vaccine Administration Procedure Codes 0144A and 0154A Are Now Benefits; Age Range Updated for Procedure Code 0134A

Date: November 10, 2022

Attention: All Providers

Effective date: October 12, 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 October 12, 2022, in accordance with the U.S. Food and Drug Administration Emergency Use Authorization, COVID-19 vaccine administration codes 0144A and 0154A are benefits of Medicaid and the Children with Special Health Care Needs (CSHCN) Services Program.

The procedure codes are benefits for the administration of the Omicron-specific, bivalent booster dose of the following:

• Moderna (0144A) COVID-19 vaccine to individuals 6 years through 11 years of age
• Pfizer-BioNTech (0154A) COVID-19 vaccine to individuals 5 years through 11 years of age

Vaccine procedure codes 91314 and 91315 are informational only while the vaccine is distributed to providers free of charge.

Procedure codes 0144A and 0154A are Medicaid 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 Health 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

 

Procedure codes 0144A and 0154A are CSHCN Services Program benefits for the following providers and places of service:

 

Place of Service	Provider Type
Office	PA, NP, CNS, Physician, Pharmacist, FQHCs, Nephrology (Hemodialysis, Renal Dialysis), RHCs, Pharmacy
Home	PA, NP, CNS, Physician, Home Health Agency, CCP Provider
Outpatient Hospitals	FQHCs, Hospitals, Nephrology (Hemodialysis, Renal Dialysis), Renal Dialysis Facility, RHCs
Other Locations	PA, NP, CNS, Physician, FQHCs, CCP Provider, RHCs

As of October 12, 2022, procedure code M0201 (COVID-19 vaccine administration inside a patient’s home) can be billed in the home setting with procedure codes 0144A or 0154A for individuals 6 years through 11 years of age and for individuals 5 years through 11 years of age.

Procedure Code 0134A Age Range Update

Effective for dates of service on or after October 12, 2022, the age range for COVID-19 vaccine administration code 0134A has changed from 18 years of age or older to 12 years of age or older.

This procedure code is a benefit of Medicaid, Healthy Texas Women, the Family Planning Program, and the Children with Special Health Care Needs Services Program for the administration of the Moderna COVID-19 Omicron-specific, bivalent booster dose to individuals 12 years of age or older.

How this impacts providers: As of October 12, 2022

• Providers can be reimbursed for administration of:
  • Moderna (0144A) COVID-19 vaccine to individuals 6 years through 11 years of age
  • Pfizer-BioNTech (0154A) COVID-19 vaccine to individuals 5 years through 11 years of age
• Providers can be reimbursed for administration of Providers are not required to appeal the claims unless they are denied for additional reasons after the claims reprocessing is complete.
• Procedure code M0201 (COVID-19 vaccine administration inside a patient’s home) can be billed in the home setting with procedure code 0134A for individuals 12 years of age or older.

Providers interested in enrolling as a COVID-19 vaccinator should visit www.dshs.texas.gov/coronavirus/immunize/provider-information.aspx for more information.

Resource:

https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-authorizes-moderna-and-pfizer-biontech-bivalent-covid-19-vaccines

 

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