Provider Alert! Update to COVID-19 Monoclonal Antibody Therapy Administration Codes 0034A and 0064A are Now Medicaid and CHIP Benefits

Date: November 17, 2021

Attention: All Providers

Effective Date: Dates of service on or after October 20, 2021

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: Effective for dates of service on or after October 20, 2021, in accordance with the U.S. Food and Drug Administration (FDA) amendments to the Emergency Use Authorizations (EUAs), COVID-19 vaccine administration procedure codes 0034A and 0064A are now benefits of Medicaid and CHIP.

How this impacts providers: The FDA amendments to the EUAs allow the following:

• The use of a single booster dose of the Janssen COVID-19 vaccine (procedure code 0034A), at least two months after completion of the single-dose primary regimen to individuals who are 18 years of age and older.
• The use of a single booster dose of the Moderna COVID-19 vaccine (procedure code 0064A), at least six months after completion of the primary series in:
• Individuals 65 years of age and older.
• Long-term care facility residents.
• Individuals 18 through 64 years of age with underlying medical conditions.
• Individuals 18 through 64 years of age at increased risk for exposure and transmission due to occupational or institutional setting.

Note: Moderna COVID-19 vaccine procedure code 91306 is processed as informational only.

• The use of any of the available COVID-19 vaccines as a heterologous (“mix and match”) booster dose in eligible individuals after completion of the primary vaccination with a different COVID-19 vaccine.

Procedure code M0201 (COVID-19 vaccine administration inside a patient’s home) can be billed in the Home setting with procedure code 0034A or 0064A, as of October 20, 2021.

Providers may bill MCOs retroactively for COVID-19 vaccine administration code 0034A or 0064A provided on or after October 20, 2021. TCHP must reprocess affected claims submitted with the procedure code and date of service on or after October 20, 2021. Providers are not required to appeal the claims unless they are denied for additional reasons after the claims reprocessing is complete.

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.