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 applicable for the following ages:

Procedure Codes	Age Range
90480	6 months of age or older
91318	6 months through 4 years of age
91319	5 years through 11 years of age
91320	12 years of age or older
91321	6 months through 11 years of age
91322	12 years of age or older

Vaccine procedure codes 91318, 91319, 91320, 91321, and 91322, and vaccine administration procedure code 90480 are Medicaid and CHIP benefits that may be reimbursed for the following provider types and places of service:

Place of Service	Provider Type
Office	Physician, Physician Assistant, Nurse Practitioner, Clinical Nurse Specialist, Pharmacist, Certified Nurse Midwife, Registered Nurse, Licensed Midwife, Comprehensive Care Program (CCP), Nephrology (Hemodialysis, Renal Dialysis), Pharmacy
Home	Physician, Physician Assistant, Nurse Practitioner, Clinical Nurse Specialist, CCP Providers, Home Health Agency
Outpatient Hospital	Hospital, Nephrology (Hemodialysis, Renal Dialysis), Renal Dialysis Facility
Other Locations	Physician, Physician Assistant, Nurse Practitioner, Clinical Nurse Specialist, CCP Providers

Additional information:

Texas Health Steps providers may be reimbursed for services rendered to members who are 6 months through 20 years of age in the office, home, outpatient hospital, and other location settings.
As of September 11, 2023, procedure code M0201 (COVID-19 vaccine administration inside a patient’s home) may be billed in the home setting with procedure code 90480.
Immunization counseling is included in procedure code 90480. Procedure code G0315 cannot be billed on the same day by the same provider as procedure code 90480.
Vaccines administered to individuals eligible for the Vaccines for Children (VFC) program should come from VFC-provided stocks. TMHP will process COVID-19 vaccine products submitted for reimbursement as informational only when administered to individuals 6 months through 18 years of age.
Managed care organizations (MCOs) must reprocess affected claims submitted with these procedure codes and date of service on or after September 11, 2023. Providers are not required to appeal the claims unless they are denied for additional reasons after the claims reprocessing is complete. Providers may bill MCOs retroactively for COVID-19 vaccine and vaccine administration procedure codes 91318, 91319, 91320, 91321, 91322, and 90480.
As a reminder, Texas Medicaid and CHIP do not cover vaccines that are not authorized or approved by the FDA.

Next step for Providers: Providers should share this communication with their staff. Providers are not required to appeal the claims unless they are denied for additional reasons after the claims reprocessing is complete.

If you have any questions, please email Provider Relations at: providerrelations@texaschildrens.org.

For access to all provider alerts,log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.