Effective for dates of service on or after October 1, 2024, some COVID-19 vaccine procedure codes will no longer be a benefit for Texas Medicaid and CHIP. These changes reflect the discontinued coverage of COVID-19 vaccines that do not have full approval by the U.S. Food and Drug Administration (FDA) by the end of the American Rescue Plan Act (ARPA) period.
The following COVID-19 vaccine procedure codes will no longer be a benefit: 91304, 91318, 91319, 91321. Note: Reimbursement rates for procedure codes 91304, 91318, 91319, and 91321 will be published in a public hearing to be made not a payable benefit.
The following COVID-19 vaccine procedure codes will continue to be a benefit as they have full approval from the FDA: 91320, 91322.
Providers may still obtain all available vaccines recommended by the Advisory Committee on Immunization Practices for children (birth through 18 years of age) at no cost from the Texas Vaccines for Children (TVFC) Program. More information about the TVFC Program can be found at https://www.dshs.texas.gov/immunizations/providers/overview.
For more information, call the TMHP Contact Center at 800-925-9126.
Providers are encouraged to share this information with their staff. If you have any questions about this notice, please email Provider Relations at ProviderRelations@cfhp.com or call 210-358-6294. You can also contact your Provider Relations Representative directly.
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