If you are Texas Children’s Health Plan Member, we have tips that can help you deal with the severe weather. Learn more
Si eres miembro de Texas Children’s Health Plan, tenemos consejos que pueden ayudarte a lidiar con el clima severo. Aprende Más
COVID-19 Vaccine Procedure Code 91323 a Benefit for Texas Medicaid and Healthy Texas Women
Date: January 26, 2026
Attention: Providers
Effective date: January 1, 2026
Call to action: The purpose of this communication is to inform providers that effective for dates of service on or after January 1, 2026, the COVID-19 vaccine (procedure code 91323) is a benefit of Texas Medicaid and the Healthy Texas Women (HTW) program.
How this impacts providers:
Texas Medicaid
The Texas Medicaid & Healthcare Partnership (TMHP) will consider claims for vaccine procedure code 91323 and vaccine administration procedure code 90480 for clients who are 12 years of age or older for the following provider types and places of service:
| Place of Service | Provider Type |
| Office | Physician, physician assistant, nurse practitioner, clinical nurse specialist, pharmacist, certified nurse midwife, registered nurse, licensed midwife, comprehensive care program (CCP) provider, nephrology (hemodialysis, renal dialysis) provider, pharmacy |
| Home | Physician, physician assistant, nurse practitioner, clinical nurse specialist, CCP provider, home health agency |
| Outpatient Hospital | Hospital, nephrology (hemodialysis, renal dialysis) provider, renal dialysis facility |
| Other Locations | Physician, physician assistant, nurse practitioner, clinical nurse specialist, CCP provider |
HTW
TMHP will consider claims for vaccine procedure code 91323 and vaccine administration procedure code 90480 for clients who are 12 years of age or older for the following provider types and places of service:
| Place of Service | Provider Type |
| Office | Physician, physician assistant, nurse practitioner, clinical nurse specialist, pharmacist, certified nurse midwife, registered nurse, licensed midwife, CCP provider, family planning clinic, nephrology (hemodialysis, renal dialysis) provider, pharmacy |
| Home | Physician, physician assistant, nurse practitioner, clinical nurse specialist, CCP provider, home health agency |
| Outpatient Hospital | Hospital, family planning clinic, nephrology (hemodialysis, renal dialysis) provider, renal dialysis facility |
| Other Locations | Physician, physician assistant, nurse practitioner, clinical nurse specialist, CCP provider |
Claims Reprocessing
TMHP will reprocess any affected claims with dates of service on or after January 1, 2026. Providers may receive additional reimbursement, which will be reflected on future Remittance and Status (R&S) Reports.
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.