10/05/2023
What’s New
Effective for dates of service on or after September 1, 2023, the procedure code 90677- Pneumococcal 20-valent conjugate vaccine, use expanded to individuals 2 months of age or older.
Reimbursement
Note: The above vaccines distributed by the Texas Vaccines for Children (TVFC) Program are processed as informational only on Texas Medicaid fee-for-service claims for clients who are 2 months or older. However, these procedure codes are reported for the administration of the vaccine, which allows the provider to be reimbursed for the administration service.
Claims Reprocessing
Claims with procedure codes 90677 with dates of service from September 1, 2023, through October 1, 2023, 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.
Resources
Vaccine Information Statements (VIS) – Immunization Unit
Questions
Providers, for questions or additional information, please:
- Contact your Medicaid Provider Network Representative 1-855-212-1615
- 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.