Effective for dates of service on or after October 1, 2023, vaccine services benefits will change for Texas Medicaid. Providers have 95 days to submit their claims.
Vaccine Services to Become Benefits
On June 27, 2023, the Centers for Medicare & Medicaid Services (CMS) issued guidance on Section 11405 of the Inflation Reduction Act (IRA). Beginning October 1, 2023, statutory amendments made by Section 11405 of the IRA require Medicaid coverage and payment for all adult vaccines approved by the U.S. Food and Drug Administration (FDA) and recommended by the Advisory Committee on Immunization Practices (ACIP) and their administration for individuals 19 years of age and older. Occupation and travel will be added to the reasons for vaccinating outside the routine schedule.
The following procedure codes will become benefits of Texas Medicaid and may be reimbursed to physician assistants, nurse practitioners, clinical nurse specialists, and physician providers for services rendered in the office setting and to hospital providers for services rendered in the outpatient hospital setting:
Procedure code 90675 will no longer be diagnosis restricted.
Respiratory Syncytial Virus (RSV) Vaccines
Procedure codes 90678 and 90679 for RSV vaccines will become benefits of Texas Medicaid and may be reimbursed as follows for clients who are 60 years of age or older:
Smallpox/Mpox Vaccines
Smallpox/Mpox vaccines (procedure codes 90611 and 90622) are informational only as these products are provided by the federal government.
Exclusions
Vaccines that are not approved or authorized for emergency use by the U.S. Food and Drug Administration and not recommended by the Advisory Committee on Immunization Practices are not benefits of Texas Medicaid.
Next steps for Providers:
Providers should share this communication with their staff.
Community First Resources:
Contact:
Email ProviderRelations@cfhp.com or call 210-358-6294.