Provider Alert! COVID-19 Vaccine Booster Update

Date: January 31, 2022

Attention: All Providers

Effective Date: January 3, 2022 for Pfizer COVID-19 Vaccine Booster Dose Age Change

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: On January 3, 2022, the U.S. Food and Drug Administration (FDA) amended the emergency use authorization (EUA) for the Pfizer-BioNTech COVID-19 vaccine to approve a booster dose to individuals 12 years and older.

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 five months after completion of the primary series for all adults 18 years of age and older.
• The use of a single booster dose of the Pfizer COVID-19 vaccine (procedure code 0004A), at least five months after completion of the primary series of the Pfizer-BioNTech COVID-19 vaccine for individuals 12 years of age and older.

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 will 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