June 21, 2022
What is New
For dates of service on or after May 17, 2022, the U.S. Food and Drug Administration (FDA) issued an Emergency Use Authorization (EUA) of the vaccine administration procedure code 0074A for the administration of the booster dose of the Pfizer-BioNTech COVID-19 vaccine as benefits of Medicaid for individuals five through 11 years of age.
Vaccine procedure code 91307 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 code 0074A with dates of service on or after May 17, 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:
Vaccine Code |
Use |
Description |
0074A |
Admin |
Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 10 mcg/0.2 mL dosage, diluent reconstituted, trissucrose formulation; booster dose |
M0201 |
Admin (Setting: Home or residence) |
COVID-19 vaccine administration inside a patient's home; reported only once per individual home per date of service when only COVID-19 vaccine administration is performed at the patient's home |
91307 |
Information Only |
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 10 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation, for intramuscular use |
0074A is a benefit 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 (Hemodialysis, Renal Dialysis), Rural Health Clinics, Pharmacy
- 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