Texas Medicaid Vaccine Updates for Procedure Code M0201

03/27/2024

Reminder:

Effected January 1, 2024, vaccine administration add-on procedure code M0201 may be billed in the home setting with the following vaccines codes:

Vaccine claims submission information:

REMINDERS:

M0201 payable as an add-on code when administered inside a home setting, if billed with any other these vaccines, along with the existing COVID-19 vaccine administration procedure code.

CLAIMS REPROCESSING

Claims with these procedure codes listed above with dates of service on or after January 1, 2024, must be reprocessed for appropriate payment. Blue Cross and Blue Shield of Texas does not require providers to submit an appeal unless they are denied for other reasons after the claims reprocessing is complete.

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

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.