COVID-19 Vaccine Administration Procedure Codes Age Range Has Changed to 12 Years of Age or Older

Date: October 3, 2022 Attention: All Providers Effective date: August 19, 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 August 19, 2022, the age range for COVID-19 vaccine administration codes 0041A and 0042A has changed from 18 years of age or older to 12 years of age or older. These procedure codes are benefits for the administration of the first and second dose of the primary series of the Novavax COVID-19 vaccine. Resource:https://www.fda.gov/emergency-preparedness-and-response/coronavirus-disease-2019-covid-19/novavax-covid-19-vaccine-adjuvanted HHSC will continue to cover procedure codes 0041A and 0042A as non-risk payments. Vaccine procedure code 91304 is informational only while the vaccine is distributed to providers free of charge. How this impacts providers: Effective August 19, 2022, procedure code M0201 (COVID-19 vaccine administration inside a patient’s home) can be billed in the home setting with procedure codes 0041A and 0042A for individuals 12 years of age or older. 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