Effective for dates of service on or after May 17, 2022, in accordance with the U.S. Food and Drug Administration (FDA) amendment to the Emergency Use Authorization (EUA), COVID-19 vaccine administration code 0074A is a benefit of Medicaid and CHIP for the administration of the booster dose of the Pfizer-BioNTech COVID-19 vaccine for individuals five through 11 years of age.

HHSC will cover procedure code 0074A as a non-risk payment.

Vaccine procedure code 91307 is information only while the vaccine is distributed to providers free of charge.

Procedure code 0074A is benefit for the following providers and places of service:

As of May 17, 2022, procedure code M0201 (COVID-19 vaccine administration inside a patient’s home) can be billed in the home setting with procedure code 0074A.

MCOs must reprocess affected claims submitted with the procedure code and date of service on or after May 17, 2022. Providers are not required to appeal the claims unless they are denied for additional reasons after the claims reprocessing is complete. Providers may bill MCOs retroactively for COVID-19 vaccine administration code 0074A for individuals five through 11 years of age.

Providers in MCO networks interested in enrolling as a COVID-19 vaccinator should visit www.dshs.texas.gov/coronavirus/immunize/provider-information.aspx for more information.

https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update- fda-expands-eligibility-pfizer-biontech-covid-19-vaccine-booster-dose

COVID-19 Vaccine Administration Procedure Code 0074A Is Now a Benefit | TMHP

For additional information, contact the Provider Relations division at (210) 358-6294 or by email at ProviderRelations@CFHP.com.

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