February 8, 2023
What is New
For dates of service on or after December 8, 2022, the U.S Food and Drug Administration (FDA) issued an Emergency Use Authorization (EUA) of the Moderna- 0614A and Pfizer-BioNTech- 0173A vaccine codes as benefits of Medicaid and CHIP. The following are the age requirements:
- Procedure code 0164A is used to report the bivalent booster vaccine of the Moderna COVID-19 vaccine to individuals 6 months through 5 years of age.
- Procedure code 0173A is used to report the bivalent booster vaccine of the Pfizer-BioNTech COVID-19 vaccine to individuals 6 months through 4 years of age.
Vaccine procedure codes 91316 (Moderna) and 91317 (Pfizer-BioNTech) are informational only, while the vaccine is distributed to the provider free of charge.
Reimbursement
We won't reimburse for Moderna or Pfizer-BioNTech COVID-19 vaccines that providers received for free. Providers should not charge members for these vaccines. We will reimburse for the administration of the vaccines. 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 0164A and 0173A with dates of service on or after December 8, 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 |
0164A |
Admin |
Moderna - Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, bivalent, preservative free, 10 mcg/0.2 mL dosage, booster dose
|
0173A |
Admin |
Pfizer-BioNTech - Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, bivalent spike protein, preservative free, 3 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation, third dose |
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 |
91316 |
Vaccine Information Only |
Moderna - severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, bivalent, preservative free, 10 mcg/0.2 mL dosage, for intramuscular use |
91317 |
Vaccine Information Only |
Pfizer-BioNTech - severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA- LNP, bivalent spike protein, preservative free, 3 mcg/0.2 mL dosage, diluent reconstituted, tris- sucrose formulation, for intramuscular use |
0164A and 0173A are Medicaid and CHIP benefits for the following Providers and Places of Service (POS):
- Office: Physician Assistant, Nurse Practitioner, Clinical Nurse Specialist, Physician, Pharmacist, Certified Nurse Midwife, Federally Qualified Healthcare Centers, Nephrology (Hemodialysis, Renal Dialysis, Rural Health Clinics (Freestanding/Independent and Hospital-based), Pharmacy
- Home: Physician Assistant, Nurse Practitioner, Clinical Nurse Specialist, Physician, Home Health Agency, Comprehensive Care Program Provider
- Outpatient Hospitals: Federally Qualified Healthcare Centers, Hospitals, Nephrology (Hemodialysis, Renal Dialysis), Renal Dialysis Facility, Rural Health Clinics (Freestanding/Independent and Hospital-based)
- Other Locations: Physician Assistant, Nurse Practitioner, Clinical Nurse Specialist, Physician, Federally Qualified Healthcare Center, Comprehensive Care Program Provider
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
- Submit via email Texas Medicaid Network Department