08/20/2024
What is New
For dates of service on or after September 1,2024, the influenza vaccine, procedure code 90653, will become a benefit for Texas Medicaid individuals 65 years of age or older.
Highlights:
Vaccine procedure code 90653 may be reimbursed when billed with corresponding vaccine administration procedure code 90471 or 90472 and the following types and places of services:
- Office: Physician Assistant, Nurse Practitioner, Clinical Nurse Specialist, Physician, Pharmacist, Certified Nurse Midwife, Registered Nurse, Licensed Midwife, Comprehensive Care Program, and Pharmacy
- Home: Physician, and Comprehensive Care Program Provider
- Outpatient Hospital: Hospital, Nephrology (Hemodialysis, Renal Dialysis) Renal Dialysis Facility
- Other Locations: Physician Assistant, Nurse Practitioner, Clinical Nurse Specialist, and Physician, Comprehensive Care Program Provider
Questions
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
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.