Effective 10/1/24: Some COVID-19 Vaccine Procedure Codes No Longer a Benefit of Medicaid and CHIP

Date: 09/26/24

Effective for dates of service on or after October 1, 2024, some COVID-19 vaccine procedure codes will no longer be a benefit for Superior HealthPlan Medicaid (STAR, STAR Health, STAR Kids, STAR+PLUS) and Children’s Health Insurance Plan (CHIP). These changes reflect the discontinued coverage of COVID-19 vaccines that did not have full approval by the U.S. Food and Drug Administration (FDA) at the end of the American Rescue Plan Act (ARPA) period.

The following COVID-19 vaccine procedure codes will no longer be a benefit:

Procedure Codes
91304	91318	91319	91321

 

Note: Reimbursement rates for procedure codes 91304, 91318, 91319, and 91321 will be published in a public hearing to be made not a payable benefit.

The following COVID-19 vaccine procedure codes will continue to be a benefit as they have full approval from the FDA:

Procedure Codes
91320	91322

 

Providers may still obtain all available vaccines recommended by the Advisory Committee on Immunization Practices for children (birth through 18 years of age) at no cost from the Texas Vaccines for Children (TVFC) Program. More information about the TVFC Program can be found by visiting The Texas Department of State Health Services (DSHS) Program Overview webpage.

Note: As a reminder, home health and dental providers should continue to discontinue the use of these codes and the additional codes as mentioned in the Effective 10/1/24: COVID-19 Vaccine Administration Updates for Medicaid and CHIP web article previously posted.

For questions, please contact your designated Account Manager. To access their contact information visit, Find My Account Manager.