July 26, 2022
What is New
For dates of service on or after June 17, 2022, the U.S Food and Drug Administration (FDA) issued an Emergency Use Authorization (EUA) of the vaccine administration procedure codes 0011A, 0012A, and 0013A, for the administration of the Moderna COVID-19 vaccine as benefits of Medicaid and CHIP for individuals 12 years of age and older.
Vaccine procedure code 91301 is informational only, while the vaccine is distributed to the provider free of charge.
Reimbursement
We won't reimburse for Moderna 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 0011A, 0012A, and 0013A with dates of service on or after June 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 |
0011A |
Admin |
Moderna Covid-19 Vaccine Administration — First Dose ADM SARSCOV2 100MCG/0.5ML1ST |
0012A |
Admin |
Moderna Covid-19 Vaccine Administration — Second Dose ADM SARSCOV2 100MCG/0.5ML2ND |
0013A |
Admin |
Moderna Covid-19 Vaccine Administration – Third Dose ADM SARSCOV2 100MCG/0.5ML3RD |
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 |
91301 |
Information Only |
Moderna Covid-19 Vaccine SARSCOV2 VAC 100MCG/0.5ML IM |
Resources
Enroll as a COVID-19 vaccinator
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.