COVID-19 Vaccine Administration Procedure Code 0174A Is Now a Benefit of Medicaid and CHIP

Date: May 16, 2023

Attention: All Providers

Effective date: Dates of service on or after March 14, 2023

Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that effective for dates of service on or after March 14, 2023, in accordance with the U.S. Food and Drug Administration’s amended Emergency Use Authorizations, COVID-19 vaccine administration procedure code 0174A for the administration of the Pfizer-BioNTech COVID-19 vaccine booster is now a benefit of Texas Medicaid and CHIP for individuals 6 months through 4 years of age.

How this impacts providers: Vaccine procedure code 91317 will be informational only while the vaccine is distributed to providers free of charge.

COVID-19 vaccine administration procedure code 0174A is a benefit of Medicaid and CHIP for the following providers and places of service:

Place of Service	Provider Type
Office	Physician Assistant (PA), Nurse Practitioner (NP), Clinical Nurse Specialist (CNS), Physician, Pharmacist, Certified Nurse Midwife (CNM), Federally Qualified Healthcare Centers (FQHCs), Nephrology (Hemodialysis, Renal Dialysis), Rural Health Clinics (RHCs), Pharmacy
Home	PA, NP, CNS, Physician, Home Health Agency, Comprehensive Care Program (CCP) Provider
Outpatient Hospitals	FQHCs, Hospitals, Nephrology (Hemodialysis, Renal Dialysis), Renal Dialysis Facility, RHCs
Other Locations	PA, NP, CNS, Physician, FQHCs, CCP Provider, RHCs

As of March 14, 2023, procedure code M0201 (COVID-19 vaccine administration inside a patient’s home) can be billed in the home setting with procedure code 0174A for individuals 6 months through 4 years of age.

Next steps 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.
Providers may bill TCHP retroactively for COVID-19 vaccine administration code 0174A for individuals 6 months through 4 years of age.
Providers interested in enrolling as a COVID-19 vaccinator should visit www.dshs.texas.gov/coronavirus/immunize/provider-information.aspx for more information.

Resources for providers:

Coronavirus (COVID-19) Update: FDA Authorizes Bivalent Pfizer-BioNTech COVID-19 Vaccine as Booster Dose for Certain Children 6 Months through 4 Years of Age | FDA

https://www.cdc.gov/media/releases/2023/s0419-covid-vaccines.html

https://www.cdc.gov/coronavirus/2019-ncov/vaccines/stay-up-to-date.html

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.