12/22/2023
What is New
For dates of service on or after October 3, 2023, the U.S. Food and Drug Administration (FDA) amended the Emergency Use Authorization (EUA) vaccine procedure codes 91304 for the Novavax COVID-19 vaccine as covered benefits for individuals 12 years of age and older.
Highlights:
- Vaccine procedure code 91304 may be billed with vaccine administration procedure code 90480 and receive reimbursed for the following types and places of services:
- Office: Physician Assistant, Nurse Practitioner, Clinical Nurse Specialist, Physician, Pharmacist, Certified Nurse Midwife, Registered Nurse, Licensed Midwife, Nephrology (Hemodialysis, Renal Dialysis, Pharmacy
- Home: Physician Assistant, Nurse Practitioner, Clinical Nurse Specialist, Physician, Home Health Agency, Comprehensive Care Program Provider
- Outpatient Hospital: Hospitals, Nephrology (Hemodialysis, Renal Dialysis), Renal Dialysis Facility,
- Other Locations: Physician Assistant, Nurse Practitioner, Clinical Nurse Specialist, Physician, Comprehensive Care Program Provider
How does this impact me
- Ages 12 through 20 years of age with Texas Health Steps may be reimbursed for services rendered in the office, home, outpatient hospital, and other location settings
- Health Texas Women (HTW) and the Family Planning Program (FFP) providers may also be reimbursed for services rendered in family planning clinics.
- Providers may administer vaccine to eligible individuals ages 6 months through 18 years of age for the Vaccine for Children (VFC) program and should come from VFC – provided stocks.
- You do not have to resubmit claims with procedure codes 91304 and dates of service on or after October 3, 2023, will be reprocessed for appropriate payment. However, you will need to resubmit any claim denied for other reasons after the claims reprocessing is complete.
Resources
- Providers interested in enrolling as COVID-19 vaccinators.
- COVID-19 Update to FDA Authorization Updated use of Novavax COVID-19 Vaccine
Providers, for questions or additional information, please
- Contact your Medicaid Provider Network Representative at 1-855-212-1615
- Submit via email Texas Medicaid Network Department.