Provider Alert! COVID-19 Vaccine Administration Procedure Codes 0164A and 0173A are Now Benefits of Medicaid and CHIPTexas Children's Health Plan
Date: February 10, 2023
Attention: All Providers
Effective date: Dates of service on or after December 8, 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 December 8, 2022, in accordance with the U.S. Food and Drug Administration’s amended Emergency Use Authorizations, COVID-19 vaccine administration codes 0164A (Moderna) and 0173A (Pfizer-BioNTech) are now benefits of Medicaid and CHIP for administration of the following:
- Moderna COVID-19 bivalent booster vaccine to individuals 6 months through 5 years of age
- Pfizer-BioNTech COVID-19 bivalent booster vaccine to individuals 6 months through 4 years of age
How this impacts providers: Vaccine procedure codes 91316 (Moderna) and 91317 (Pfizer-BioNTech) are informational only while the vaccine is distributed to providers free of charge.
Procedure codes 0164A and 0173A are benefits of Medicaid and CHIP 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|
As of December 8, 2022, procedure code M0201 (COVID-19 vaccine administration inside a patient’s home) can be billed in the home setting with procedure codes 0164A or 0173A for individuals 6 months through 5 years of age or 6 months through 4 years of age, respectively.
Next steps for providers:Providers should share this communication with their staff. Providers are not required to appeal the claims unless they are denied for additional reasons after the claims reprocessing is complete.
If you have any questions, please email Provider Relations at: email@example.com.
For access to all provider alerts, log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.