Reimbursement for COVID-19 Vaccines for FQHCs and RHCs Reminder

Date: July 13, 2023

Attention: FQHC and RHC Providers

End date for vaccine procedure codes: May 12, 2023

Call to action: Texas Children’s Health Plan (TCHP) would like to remind FQHC and RHC providers of the guidance from Texas Medicaid and Healthcare Partnership (TMHP) on COVID-19 vaccine procedure codes. Effective for dates of service on or after May 12, 2023, claims submitted by federally qualified health centers (FQHCs) and rural health clinics (RHCs) for the administration of COVID-19 vaccines will no longer be reimbursed. The Texas Health and Human Services Commission (HHSC) has directed the Texas Medicaid & Healthcare Partnership (TMHP) to stop payments due to the end of the public health emergency (PHE).

How this impacts providers: Here is a complete list of the COVID-19 vaccine administration procedure codes that will not be reimbursed to FQHCs and RHCs for dates of service on or after May 12, 2023.

Please note the following:

• Claims with the procedure codes listed in this table that were submitted by FQHCs and RHCs from May 12, 2023, through May 30, 2023, may be reprocessed.
• Affected claims may result in recoupment, which will be reflected on future Remittance and Status Reports.
• Previously, these codes were reimbursed at the fee schedule rate when billed on a different DOS from an encounter. 

Next step for Providers: Providers should share this communication with their billing staff.

If you have any questions, please email Provider Relations at: providerrelations@texaschildrens.org.

For access to all provider alerts,log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.