COVID-19 Vaccine Administration Procedure Codes 0144A and 0154A Are Now Benefits; Age Range Updated for Procedure Code 0134A
Date: November 10, 2022Attention: All ProvidersEffective date: October 12, 2022Providers 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 October 12, 2022, in accordance with the U.S. Food and Drug Administration Emergency Use Authorization, COVID-19 vaccine administration codes 0144A and 0154A are benefits of Medicaid and the Children with Special Health Care Needs (CSHCN) Services Program.
The procedure codes are benefits for the administration of the Omicron-specific, bivalent booster dose of the following:
Moderna (0144A) COVID-19 vaccine to individuals 6 years through 11 years of age
Pfizer-BioNTech (0154A) COVID-19 vaccine to individuals 5 years through 11 years of age
Vaccine procedure codes 91314 and 91315 are informational only while the vaccine is distributed to providers free of charge.
Procedure codes 0144A and 0154A are Medicaid benefits for the following providers and places of service:
As of October 12, 2022, procedure code M0201 (COVID-19 vaccine administration inside a patient’s home) can be billed in the home setting with procedure codes 0144A or 0154A for individuals 6 years through 11 years of age and for individuals 5 years through 11 years of age.
Procedure Code 0134A Age Range Update
Effective for dates of service on or after October 12, 2022, the age range for COVID-19 vaccine administration code 0134A has changed from 18 years of age or older to 12 years of age or older.
This procedure code is a benefit of Medicaid, Healthy Texas Women, the Family Planning Program, and the Children with Special Health Care Needs Services Program for the administration of the Moderna COVID-19 Omicron-specific, bivalent booster dose to individuals 12 years of age or older.
How this impacts providers: As of October 12, 2022
Providers can be reimbursed for administration of:
Moderna (0144A) COVID-19 vaccine to individuals 6 years through 11 years of age
Pfizer-BioNTech (0154A) COVID-19 vaccine to individuals 5 years through 11 years of age
Providers can be reimbursed for administration of Providers are not required to appeal the claims unless they are denied for additional reasons after the claims reprocessing is complete.
Procedure code M0201 (COVID-19 vaccine administration inside a patient’s home) can be billed in the home setting with procedure code 0134A for individuals 12 years of age or older.
