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WARNING: THIS IS A TEXAS HEALTH AND HUMAN SERVICES INFORMATION RESOURCES SYSTEM THAT CONTAINS STATE AND/OR U.S. GOVERNMENT INFORMATION. BY USING THIS SYSTEM YOU ACKNOWLEDGE AND AGREE THAT YOU HAVE NO RIGHT OF PRIVACY IN CONNECTION WITH YOUR USE OF THE SYSTEM OR YOUR ACCESS TO THE INFORMATION CONTAINED WITHIN IT. BY ACCESSING AND USING THIS SYSTEM YOU ARE CONSENTING TO THE MONITORING OF YOUR USE OF THE SYSTEM, AND TO SECURITY ASSESSMENT AND AUDITING ACTIVITIES THAT MAY BE USED FOR LAW ENFORCEMENT OR OTHER LEGALLY PERMISSIBLE PURPOSES. ANY UNAUTHORIZED USE OR ACCESS, OR ANY UNAUTHORIZED ATTEMPTS TO USE OR ACCESS, THIS SYSTEM MAY SUBJECT YOU TO DISCIPLINARY ACTION, SANCTIONS, CIVIL PENALTIES, OR CRIMINAL PROSECUTION TO THE EXTENT PERMITTED UNDER APPLICABLE LAW.
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AMA/ADA End User License Agreement
LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT® ")

You, your employees and agents are authorized to use CPT only as contained in materials on the Texas Medicaid & Healthcare Partnership (TMHP) website solely for your own personal use in directly participating in healthcare programs administered by THHS. You acknowledge that AMA holds all copyright, trademark and other rights in CPT.

Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. License to use CPT for any use not authorized herein must be obtained through the American Medical Association, Intellectual Property Services, 515 N. State Street, Chicago, Illinois, 60610. Applications are available at the American Medical Association website, www.ama-assn.org/go/cpt.

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This product includes CPT which is commercial technical data and/or computer databases and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60610. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer databases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2) (November 1995) and/or subject to the restrictions of DFARS 227.7202-1(a) (June 1995) and DFARS 227.7202-3(a) (June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal procurements.

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1. Subject to the terms and conditions contained in this Agreement, you, your employees and agents are authorized to use CDT only as contained in the following authorized materials and solely for internal use by yourself, employees and agents within your organization within the United States and its territories. Use of CDT is limited to use in programs administered by Centers for Medicare & Medicaid Services (CMS). You agree to take all necessary steps to ensure that your employees and agents abide by the terms of this agreement. You acknowledge that the ADA holds all copyright, trademark and other rights in CDT. You shall not remove, alter, or obscure any ADA copyright notices or other proprietary rights included in the materials.

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COVID-19 Vaccine Administration Procedure Codes 0081A, 0082A, 0083A, 0111A, 0112A, and 0113A Are Now Benefits for Medicaid and CSHCN

Last updated on 7/29/2022

Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to eligible clients. Administrative procedures such as prior authorization, precertification, referrals, and claims/encounter data filing may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should contact the client's specific MCO for details.

Effective for dates of service on or after June 17, 2022, COVID-19 vaccine administration procedure codes 0081A, 0082A, 0083A, 0111A, 0112A, and 0113A are benefits of Texas Medicaid and the Children with Special Health Care Needs (CSHCN) Services Program.

Age Requirements

The U.S. Food and Drug Administration amended the Emergency Use Authorizations for the Pfizer-BioNTech and Moderna COVID-19 vaccines. The following are the age requirements for these procedure codes:

Procedure codes 0081A, 0082A, and 0083A are used to report the administration of the first, second, and third doses of the primary series of the Pfizer COVID-19 vaccine to children 6 months through 4 years of age.
Procedure codes 0111A, 0112A, and 0113A are used to report the administration of the first and second doses of the primary series and the third dose of the Moderna COVID-19 vaccine to children 6 months through 5 years of age.

Vaccine procedure codes 91308 (Pfizer-BioNTech) and 91311 (Moderna) are informational only while the vaccine is distributed to providers free of charge.

For more information, visit https://www.cdc.gov/coronavirus/2019-ncov/vaccines/vaccines-children-teens.html.

Benefits

Procedure codes 0081A, 0082A, 0083A, 0111A, 0112A, and 0113A are Medicaid benefits for the following providers and places of service:

Medicaid

Place of Service	Provider Type
Office	County Indigent Health Care Program, Physician, Physician Group, Physician Assistant, Nurse Practitioner, Clinical Nurse Specialist, Pharmacist, Pharmacy, Certified Nurse Midwife, Registered Nurse/Licensed Midwife, Federally Qualified Health Center, Comprehensive Care Program (CCP) Provider, Nephrology (Hemodialysis, Renal Dialysis), Rural Health Clinic (Freestanding/Independent and Hospital-based)
Home	Physician, Physician Groups, Physician Assistant, Nurse Practitioner, Clinical Nurse Specialist, Home Health Agency, Comprehensive Care Program (CCP) Provider
Outpatient Hospital	Federally Qualified Health Center, Hospital, Nephrology (Hemodialysis, Renal Dialysis), Renal Dialysis Facility, Rural Health Clinic (Freestanding/Independent and Hospital-based)
Other Locations	County Indigent Health Care Program, Physician, Physician Group, Physician Assistant, Nurse Practitioner, Clinical Nurse Specialist, Federally Qualified Health Center, Comprehensive Care Program (CCP) Provider

CSHCN Services Program

Procedure codes 0081A, 0082A, 0083A, 0111A, 0112A, and 0113A are CSHCN Services Program benefits for the following providers and places of service:

Place of Service	Provider Type
Office	Physician, Physician Assistant, Advanced Practice Registered Nurse, Pharmacist, Comprehensive Care Program (CCP) Provider, Nephrology (Hemodialysis, Renal Dialysis), Rural Health Clinic (RHC)
Home	Physician, Physician Assistant, Advanced Practice Registered Nurse, Comprehensive Care Program (CCP) Provider, Comprehensive Care Program (CCP) Provider, Home Health Agency
Outpatient Hospitals	Nephrology (Hemodialysis, Renal Dialysis), Renal Dialysis Facility, Hospital Provider, Federally Qualified Healthcare Center (FQHC), Rural Health Clinic (RHC)
Other Locations	Physician, Physician Assistant, Advanced Practice Registered Nurse, Comprehensive Care Program (CCP) Provider, Federally Qualified Healthcare Center (FQHC), Rural Health Clinic (RHC)

Effective June 17, 2022, procedure code M0201 (COVID-19 vaccine administration inside a patient’s home) can be billed in the home setting with procedure codes 0081A, 0082A, 0083A, 0111A, 0112A, or 0113A for individuals 6 months through 4 and 5 years of age.

Affected claims with dates of service on or after June 17, 2022, will be reprocessed, and providers may receive additional payment. Additional payments will be reflected on future Remittance and Status (R&S) Reports. Providers are not required to appeal the claims unless they are denied for additional reasons after the claims reprocessing is complete.

Providers interested in enrolling as a COVID-19 vaccinator should visit https://www.dshs.texas.gov/coronavirus/immunize/provider-information.aspx.

For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.