Update to Smallpox and Mpox Vaccine Reimbursement for Texas Medicaid

Date: July 12, 2024

Attention: All Providers

Effective Date: August 1, 2024

Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that for dates of service on or after May 1, 2024, the smallpox and mpox vaccine (procedure code 90611) may be reimbursed for the following provider types and places of service for clients who are 18 years of age or older:

Place of Service	Provider Type
Office	Physicians, physician assistants, nurse practitioners, clinical nurse specialists
Outpatient hospital	Hospital providers

Effective August 1, 2024, for dates of service on or after May 1, 2024, procedure code 90611 will be processed with a payable rate.

Note: New benefits that are adopted by Texas Medicaid must be presented at a rate hearing to receive public comment on proposed Texas Medicaid reimbursement rates. After the rate hearing, expenditures must be approved before the rates are adopted by Texas Medicaid. Providers will be notified in a future article if a proposed reimbursement rate will change or a procedure code will not be reimbursed because the expenditures are not approved.

Next step for Providers: Providers should share this update with their staff.

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.