07/19/2024
What is New
For dates of service on or after May 1, 2024, the Smallpox and Mpox vaccine, procedure code 90611, is now a benefit for Texas Medicaid. This applies to age groups who are 18 years of age or older.
Highlights:
- Previously procedure code 90611 was for informational use only, now effective August 1, 2024, for dates of service on or after May 1, 2024, procedure code 90611 will process with payable rate.
- Vaccine procedure code 90611 may be reimbursed for the following provider types and places of services:
- Office: Physician Assistant, Nurse Practitioner, Clinical Nurse Specialist, Physician
- Outpatient Hospital: Hospital Providers
How does this impact me?
- You do not have to resubmit claims with procedure codes 90611 with dates of service on or after May 1, 2024. Claims will be automatically reprocessed for appropriate payment. However, you will need to resubmit any claim denied for other reasons after the claims reprocessing is complete.
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