Age Range Expansion for Pneumococcal 20-Valent Conjugate Vaccine

Date: September 28, 2023

Attention: Primary Care Providers

Effective date: For dates of service on or after September 1, 2023

Call to action: The purpose of this communication is to inform providers that effective for dates of service on or after September 1, 2023, the age range for procedure code 90677 was updated to individuals who are 2 months of age or older for Texas Medicaid and CHIP. Since this vaccine is distributed by the Texas Vaccines for Children (TVFC) Program, procedure code 90677 will process as informational-only when administered to individuals who are 2 months through 18 years of age.

How this impacts providers: Texas Children’s Health Plan (TCHP) will reprocess affected claims submitted with this procedure code and date of service on or after September 1, 2023.

Next step for Providers: 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 vaccine procedure code 90677 and related vaccine administration procedure code.

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.