COVID-19 Vaccine Procedure Code 91304

Date: November 27, 2023

Attention: All Providers

Effective for dates of service on or after October 3, 2023

Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that effective for dates of service on or after October 3, 2023, in accordance with the U.S. Food and Drug Administration’s (FDA) amended emergency use authorization for the Novavax COVID-19 vaccine, vaccine procedure code 91304 is now a benefit of Medicaid and CHIP.

How this impacts providers: COVID-19 vaccine procedure code 91304 is a benefit of Medicaid and CHIP for individuals who are 12 years of age or older that may be reimbursed for the following provider types and places of service:

Place of Service	Provider Type
Office	Physician, Physician Assistant, Nurse Practitioner, Clinical Nurse Specialist, Pharmacist, Certified Nurse Midwife, Registered Nurse, Licensed Midwife, Comprehensive Care Program (CCP), Nephrology (Hemodialysis, Renal Dialysis), Pharmacy
Home	Physician, Physician Assistant, Nurse Practitioner, Clinical Nurse Specialist, CCP Providers, Home Health Agency
Outpatient Hospital	Hospital, Nephrology (Hemodialysis, Renal Dialysis), Renal Dialysis Facility
Other Locations	Physician, Physician Assistant, Nurse Practitioner, Clinical Nurse Specialist, CCP Providers

Additional information:

Texas Health Steps providers may be reimbursed for services rendered to members who are 12 years through 20 years of age in the office, home, outpatient hospital, and other location settings. Healthy Texas Women (HTW) and the Family Planning Program (FPP) providers may also be reimbursed for services rendered in family planning clinics.
Vaccine procedure code 91304 may be billed with vaccine administration procedure code 90480, as of October 3, 2023.
Vaccines administered to individuals eligible for the Vaccines for Children (VFC) program should come from VFC-provided stocks. TMHP will process COVID-19 vaccine products submitted for reimbursement as informational only when administered to individuals 6 months through 18 years of age.
As a reminder, Texas Medicaid and CHIP do not cover vaccines that are not authorized or approved by the FDA.

Next step 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.

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.