February 1, 2023
What is New
Effective February 1, 2023, for dates of service on or after December 1, 2022, the U.S Food and Drug Administration (FDA) expanded the age limitations for the following vaccines:
- Procedure code 90671-Vaxneuvance™ (pneumococcal 15-valent conjugate vaccine), use expanded to individuals 6 weeks of age or older.
- Procedure code 90756- Flucelvax® Quadrivalent (influenza vaccine) use expanded to individuals 6 months of age or older.
Reimbursement
Note: The above vaccines distributed by the Texas Vaccines for Children Program are processed as informational only on Texas Medicaid fee-for-service claims for clients who are 18 years of age or younger. However, these procedure codes are reported for the administration of the vaccine, which allows the provider to be reimbursed for the administration service.
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 90671 and 90756 with dates of service on or after December 1, 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.
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