Tag - vaccine

Provider Alert! Coverage of Commercialized COVID-19 Vaccines Begins as a Pharmacy Benefit

Effective Dates: As of September 11, 2023 & October 3, 2023 Date: December 4, 2023 Attention: All Providers Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that effective for dates of service on or after September 11, 2023 and October 3, 2023, the U.S. Food and Drug Administration’s (FDA) issued approval and Emergency Use Authorization (EUA) for the following COVID-19 vaccines: As of September 11, 2023: 2023-2024 Pfizer-BioNTech COVID-19 Vaccine 2023-2024 Moderna COVID-19 Vaccine As of October 3, 2023: 2023-2024 Novavax COVID-19 Vaccine The...

Provider Alert!

Provider Alert! Synagis (palivizumab) Clinical Prior Authorization Forms Updated with Revised Abrysvo Criteria

Date: December 4, 2023 Attention: All Providers Effective date: November 17, 2023 Call to action: On November 17, 2023, Health and Human Services Commission (HHSC) updated the Synagis Standard Prior Authorization Request (HHS Form 1321) to include a step to check for Abrysvo vaccine administration to the client’s mother during 32 to 36 weeks of pregnancy. How this impacts providers: Additional information on Abrysvo Vaccine include the following: Abrysvo is indicated for active immunization of pregnant individuals at 32 through 36 weeks gestational age for...

Provider Alert! COVID-19 Vaccine Procedure Code 91304

Date: November 27, 2023 Attention: All Providers Effective for dates of service on or after October 3, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that effective for dates of service on or after October 3, 2023, in accordance with the U.S. Food and Drug Administration’s (FDA) amended emergency use authorization for the Novavax COVID-19 vaccine, vaccine procedure code 91304 is now a benefit of Medicaid and CHIP. How this impacts providers: COVID-19 vaccine procedure code 91304 is...

Provider Alert!

Provider Alert! COVID-19 Vaccine and Vaccine Administration Procedure Codes 91318, 91319, 91320, 91321, 91322, and 90480 Are Now Benefits of Medicaid and CHIP

Date: November 7, 2023 Attention: All Providers Effective for dates of service on or after September 11, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that in accordance with the U.S. Food and Drug Administration’s amended Emergency Use Authorizations COVID-19 vaccine administration codes for the Pfizer-BioNTech and Moderna COVID-19 vaccines, vaccine procedure codes 91318, 91319, 91320, 91321, 91322, and vaccine administration procedure code 90480 are benefits for Medicaid and CHIP. How this impacts providers: The procedure codes are...

Provider Alert!

Provider Alert! Vaccine Services Benefits Changes for Texas Medicaid

Date: November 6, 2023 Attention: All Providers Effective: October 1, 2023 Call to Action: Texas Children Health Plan (TCHP) would like to let providers know that effective for dates of service on or after October 1, 2023, vaccine services benefits have changed for Texas Medicaid.  On June 27, 2023, the Centers for Medicare & Medicaid Services (CMS) issued guidance on Section 11405 of the Inflation Reduction Act (IRA). Beginning October 1, 2023, statutory amendments made by Section 11405 of the IRA require Medicaid coverage...

Provider Alert!

Provider Alert! Age Range Expansion for Pneumococcal 20-Valent Conjugate Vaccine

Date: September 28, 2023 Attention: Primary Care Providers Effective date: For dates of service on or after September 1, 2023 Call to action: The purpose of this communication is to inform providers that effective for dates of service on or after September 1, 2023, the age range for procedure code 90677 was updated to individuals who are 2 months of age or older for Texas Medicaid and CHIP. Since this vaccine is distributed by the Texas Vaccines for Children (TVFC) Program, procedure code...

Provider Alert! Reimbursement for COVID-19 Vaccines for FQHCs and RHCs Reminder

Date: July 13, 2023 Attention: FQHC and RHC Providers End date for vaccine procedure codes: May 12, 2023 Call to action: Texas Children’s Health Plan (TCHP) would like to remind FQHC and RHC providers of the guidance from Texas Medicaid and Healthcare Partnership (TMHP) on COVID-19 vaccine procedure codes. Effective for dates of service on or after May 12, 2023, claims submitted by federally qualified health centers (FQHCs) and rural health clinics (RHCs) for the administration of COVID-19 vaccines will no longer be...

Provider Alert! COVID-19 Vaccine Counseling Procedure Code G0315 Now a Benefit

Date: April 14, 2023 Attention: All Providers Effective Date: Dates of service on or after December 2, 2021 Call to action: Texas Children Health Plan (TCHP) would like to inform providers that effective for dates of service on or after December 2, 2021, COVID-19 vaccine counseling procedure code G0315 is a benefit of Medicaid for individuals birth through 20 years of age. How this impacts providers: Procedure code G0315 will be limited to once per day for the same provider, as well as three...

Provider Alert! COVID-19 Vaccine Administration Procedure Codes 0164A and 0173A are Now Benefits of Medicaid and CHIP

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...

Provider Alert!

Provider Alert! Update to Age Restrictions for Vaccine Procedure Codes 90671 (Vaxneuvance) and 90756 (Flucelvax Quadrivalent)

Date: January 23, 2023 Attention: Providers Effective date: February 1, 2023 for dates of service on or after December 1, 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: The Food and Drug Administration has expanded the age limitations for the following vaccines: Vaxneuvance™ (pneumococcal 15-valent conjugate...