Update to Age Restrictions for Vaccine Procedure Codes 90671 (Vaxneuvance) and 90756 (Flucelvax Quadrivalent)

Date: January 23, 2023

Attention: Providers

Effective date: February 1, 2023 for dates of service on or after December 1, 2022

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: The Food and Drug Administration has expanded the age limitations for the following vaccines:

• Vaxneuvance™ (pneumococcal 15-valent conjugate vaccine), procedure code 90671, to be used in individuals 6 weeks of age or older
• Flucelvax® Quadrivalent (influenza vaccine), procedure code 90756, to be used in individuals 6 months of age or older

The age limitations for vaccine procedure codes will be expanded to reflect the FDA changes above. This change is effective for any procedures provided on or after December 1, 2022.

How this impacts providers:

Managed care organizations will reprocess affected claims submitted with these codes and date of service on or after December 1, 2022. 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: Prescribers should adjust their prescribing patterns accordingly and share this update with their staff as well.

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.