COVID-19 Vaccine Administration Codes 0051A, 0052A, 0053A, and 0054A for Medicaid and CHIP

March 24, 2022

What is New

For dates of service on or after January 3, 2022, the Texas Medicaid and Healthcare Partnership (TMHP) issued usage of the vaccine administration procedure codes 0051A, 0052A, 0053A, and 0054A to administer the first, second, third (additional), and booster doses for Pfizer-BioNTech COVID-19 vaccine as benefits of Medicaid and CHIP for individuals 12 years of age and older.

Vaccine procedure code 91305 is informational only, while the vaccine is distributed to the provider free of charge.

Reimbursement

We won't reimburse for Pfizer-BioNTech COVID-19 vaccines that providers received for free. Providers should not charge members for the vaccine. We will reimburse for the administration of the vaccine. Other medically necessary treatment for COVID-19 will be covered consistent with the terms of the member's benefit plan. You can also reference the CMS Medicaid toolkit for more details.

Claims Reprocessing

Claims with procedure codes 0051A, 0052A, 0053A, and 0054A with dates of service on or after January 3, 2022, must be reprocessed for appropriate payment. Blue Cross and Blue Shield of Texas (BCBSTX) does not require providers to submit an appeal unless they are denied for other reasons after the claims reprocessing is complete.

Vaccine Administration claims submission information:

0051A, 0052A, 0053A, 0054A are benefits for the following Providers and Places of Service (POS):

• Office: Physician Assistant, Nurse Practitioner, Clinical Nurse Specialist, Physician, Pharmacist, Certified Nurse Midwife, Federally Qualified Healthcare Centers, Nephrology, Rural Health Clinics, Pharmacy, Comprehensive Care Program Provider
• Home: Physician Assistant, Nurse Practitioner, Clinical Nurse Specialist, Physician, Home Health Agency, Comprehensive Care Program Provider
• Outpatient Hospital: Federally Qualified Healthcare Centers, Hospitals, Nephrology (Hemodialysis, Renal Dialysis), Renal Dialysis Facility, Rural Health Clinics
• Other Locations: Physician Assistant, Nurse Practitioner, Clinical Nurse Specialist, Physician, Federally Qualified Healthcare Centers, Comprehensive Care Program Provider, Rural Health Clinics

Resources

Providers interested in enrolling  as COVID-19 vaccinators

CMS Medicaid Toolkit   - Coverage and Reimbursement of COVID-19 Vaccines, Vaccine Administration and Cost Sharing under Medicaid, the Children’s Health Insurance Program, and Basic Health Program

Questions

Providers, for questions or additional information, please: 

• Contact your BCBSTX Medicaid Network team at 1-855-212-1615 or
• Submit via email Texas Medicaid Network Department

The above material is for informational purposes only and is not a substitute for the independent medical judgment of a physician or other health care provider. Physicians and other health care providers are encouraged to use their own medical judgment based upon all available information and the condition of the patient in determining the appropriate course of treatment. References to other third-party sources or organizations are not a representation, warranty or endorsement of such organization. Any questions regarding those organizations should be addressed to them directly. The fact that a service or treatment is described in this material is not a guarantee that the service or treatment is a covered benefit and members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions. Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider.