Provider Alert! COVID-19 Vaccines Available and Administration

Date: June 30, 2021

Attention: All Providers

Updated: May 18, 2021 with home health administration information

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 make network providers aware of the COVID-19 vaccines available through the pharmacy (retail) or medical benefit:

• Pfizer-BioNTech: effective December 11, 2020
• Moderna: effective December 18, 2020
• Janssen: effective February 27, 2021

Each vaccine has unique vaccine and administration codes listed below. For medical billing, the vaccines are payable to the following places of service and provider types:

• Office: Physician, Physician Group, Clinic/Group Practice, Physician Assistant (PA), Nurse Practitioner (NP), Clinical Nurse Specialist (CNS), Certified Nurse Midwife (CNM), Licensed Midwife (LM), Registered Nurse (RN), Pharmacist, Pharmacy, Comprehensive Care Program (CCP) Provider, Renal Dialysis Facility, County Indigent Health Care Program
• Home: Physician, Physician Group, Clinic/Group Practice, PA, NP, CNS, CCP Provider
• Outpatient Hospital: Hospital, Renal Dialysis Facility
• Other Locations: Physician, Physician Group, Clinic/Group Practice, PA, NP, CNS, CCP Provider, and County Indigent Health Care Program
• Beginning March 23, 2021, Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) can be reimbursed for COVID-19 vaccine administration services with the procedure codes listed below. If the vaccine is administered as part of an encounter (office visit) or on the same date of service as another service, there is no separate reimbursement for the administration code. It should only be reimbursed if it is the only service provided by the FQHC/RHC.
  Providers may resubmit claims for payment; timely filing guidelines for claims submissions and appeals will be waived.
• Beginning May 18, 2021, home health agencies administering medical services for Texas Medicaid clients will be reimbursed for COVID-19 vaccine procedure codes 0001A, 0002A, 0011A, 0012A, and 0031A. These providers will receive reimbursement for COVID-19 vaccine administration to clients who already have existing home health services or private duty nursing services, and for whom the physician has updated the care plan with orders for the COVID-19 vaccine. Home health agencies may bill retroactively for COVID-19 vaccine administration provided on or after May 18, 2021. Affected claims submitted with procedure codes and dates of service on or after the above listed effective date must be reprocessed. Providers are not required to appeal the claims unless they are denied for additional reasons after the claims reprocessing is complete.

How this impacts providers: Providers are not eligible for reimbursement for the vaccine codes (91300, 91301, and 91303) since the vaccines are distributed to the providers free of charge. Therefore, these codes will process as informational only. Providers are only eligible for reimbursement for the vaccine administration codes. Providers should reference the chart below for proper administration and billing codes.

Administration: COVID-19 and other vaccines may now be administered without regard to timing.  This includes simultaneous administration of COVID-19 and other vaccines on the same day, as well as co-administration within 14 days.

Next steps for providers: Providers should inform their staff of this billing information.  Providers interested in enrolling as a COVID-19 vaccinator should visit: www.dshs.texas.gov/coronavirus/immunize/provider-information.aspx. Enrollment is required to receive and administer any approved COVID-19 vaccine.

TCHP COVID-19 Vaccine webpage: https://www.texaschildrenshealthplan.org/covidvaccine

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.