New Vaccine Benefits for Texas Medicaid and the HTW Program

Date: October 31, 2025

Attention: Providers

Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that certain vaccine procedure codes have become benefits of Texas Medicaid and the Healthy Texas Women (HTW) program.

Clesrovimab

• Effective for dates of service on or after July 1, 2025, clesrovimab (procedure code 90382) has become a benefit of Texas Medicaid for clients who are birth through 7 months of age.
• Administration of clesrovimab (procedure code 90382) is limited to once per lifetime. The Texas Medicaid & Healthcare Partnership (TMHP) may deny claims that are submitted for the administration of palivizumab if clesrovimab has already been administered.

Chikungunya Vaccine

• Effective for dates of service on or after May 13, 2025, the chikungunya vaccine (procedure code 90593) has become a benefit of Texas Medicaid for clients who are 12 years of age or older.

Meningococcal Pentavalent Vaccine

• Effective for dates of service on or after June 25, 2025, the meningococcal pentavalent vaccine (procedure code 90624) has become a benefit for the following:
• Texas Medicaid clients who are 10 through 23 years of age
• HTW and HTW Plus clients who are 15 through 23 years of age

Reimbursement Rates

All new benefits must go through the Texas Medicaid rate hearing process to allow for public comment on proposed reimbursement rates. After the rate hearing, Texas Medicaid must approve the expenditures before the rates can be adopted. TMHP will notify providers in a future article if a proposed reimbursement rate will change or if claims for a procedure code will not be reimbursed because the expenditures are not approved.

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

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

For access to all provider alerts: www.texaschildrenshealthplan.org/provideralerts.