COVID-19 Moderna Vaccine Administration Procedure Codes 0011A and 0012A Rate Change Effective 4/1/2021.
On December 18, 2020, in accordance with the FDA’s issuance of Emergency Use Authorization for the Moderna COVID-19 Vaccine, vaccine administration procedure codes 0011A and 0012A are benefits for Texas Medicaid for individuals 18 years of age and older. Vaccine procedure code 91301 is informational only while the vaccine is distributed to providers free of charge.
Providers should reference the table below when submitting claims for vaccine administration:
Procedure codes 0011A and 0012A are benefits for the following providers and places of service:
|Places of Service||Provider Types|
|Office||Physician Assistant, Nurse Practitioner, Clinical Nurse Specialist, Physician, Physician Groups, Certified Nurse Midwife, Pharmacist, CCP Provider, Nephrology (Hemodialysis, Renal Dialysis), Pharmacy, Clinic/Group Practice, Licensed Midwife, Registered Nurse, County Indigent Health Care Program|
|Outpatient Hospital||Nephrology (Hemodialysis, Renal Dialysis), Hospital Providers, Renal Dialysis Facility|
|Home||Physician Assistant, Nurse Practitioner, Clinical Nurse Specialist, Physician, Physician Groups, CCP Provider, Clinic/Group Practice|
|Other Locations||Physician Assistant, Nurse Practitioner, Clinical Nurse Specialist, Physician, Physician Groups, CCP Provider, Clinic/Group Practice, County Indigent Health Care Program|
Providers should reference the table below when submitting claims for the COVID-19 vaccine and vaccine administration:
Providers should bill CPT 91301 with a charge of $0.01 as this code is informational. Beginning with Dates of Service 4/1/2021 and after the Vaccines will Pay as follows:
**Rate subject to change based on TMHP notice**
|CPT Code||CPT Short Descriptor||Labeler Name||Labeler Name||Payment Allowance|
|91301||SARSCOV2 VAC 100MCG/0.5ML IM||Moderna||Moderna Covid-19 Vaccine||$0.01|
|0011A||ADM SARSCOV2 100MCG/0.5ML1ST||Moderna||Moderna Covid-19 Vaccine Administration – First Dose||$40.00|
|0012A||ADM SARSCOV2 100MCG/0.5ML2ND||Moderna||Moderna Covid-19 Vaccine Administration – Second Dose||$40.00|