Tag - vaccine

Provider Alert!
12Jul

Provider Alert! Update to Smallpox and Mpox Vaccine Reimbursement for Texas Medicaid

Date: July 12, 2024 Attention: All Providers Effective Date: August 1, 2024 Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that for dates of service on or after May 1, 2024, the smallpox and mpox vaccine (procedure code 90611) may be reimbursed for the following provider types and places of service for clients who are 18 years of age or older: Place of ServiceProvider TypeOfficePhysicians, physician assistants, nurse practitioners, clinical nurse specialistsOutpatient hospitalHospital providers Effective August 1, 2024, for dates...

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Provider Alert!
14May

Provider Alert! Chikungunya Virus Vaccine Is Now a Benefit of Texas Medicaid

Date: May 14, 2024 Attention: All Providers Effective Date: April 1, 2024 Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that effective for dates of service on or after April 1, 2024, the chikungunya virus vaccine (procedure code 90589) is now a benefit of Texas Medicaid for clients who are 19 years of age or older. Procedure code 90589 may be reimbursed for the following provider types and places of service: Place of ServiceProvider TypeOfficePhysicians, Physician assistants, nurse practitioners, clinical...

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Provider Alert!
14May

Provider Alert! Vaccine Services Procedure Code 90623 is Now Available Through TVFC

Date: May 14, 2024 Attention: All Providers Effective Date: April 1, 2024 Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that effective for dates of service on or after April 1, 2024, vaccine services procedure code 90623 is now available through the Texas Vaccines for Children (TVFC) program for clients who are 10 years through 18 years of age. Note: Procedure codes for vaccines distributed by the Texas Vaccines for Children Program are processed as Informational on Texas Medicaid fee-for-service...

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Provider Alert!
26Feb

Provider Alert! Updates to Vaccine Administration Procedure Code M0201

Date: February 26, 2024 Attention: All Providers Effective: January 1, 2024 Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that effective January 1, 2024, vaccine administration add-on procedure code M0201 may be billed in the home setting with the following procedure codes: 906309063690654906559065690657906589066090661906629067090671906729067390674906779068290685906869068790688906949069790723907329073990740907439074490746907479075690759   M0201 will be payable as an add-on code if billed with any of these vaccines, along with the existing COVID-19 vaccine administration procedure code, if administered inside a client’s home. TCHP will reprocess affected claims submitted with the...

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05Dec

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...

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Provider Alert!
05Dec

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...

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27Nov

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...

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Provider Alert!
08Nov

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...

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Provider Alert!
08Nov

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...

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Provider Alert!
29Sep

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...

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