Update to RSV Vaccine Age Restrictions
Date: October 14, 2025
Attention: Providers
Effective date: June 25, 2025
Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that effective June 25, 2025 the age range limitations for the respiratory syncytial virus (RSV) vaccine (procedure codes 90679 and 90683) have been updated to include coverage for Texas Medicaid members 50 years of age or older. The administration code 90471 should accompany these vaccine codes.
How this impacts providers: The update to the age range limitation will be outlined in the November 2025 edition of the Texas Medicaid Provider Procedures Manual, Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook, in section 9.2.35.1, “Administration Fee,” and section 9.2.39, “Respiratory Syncytial Virus (RSV).”
Claims information:
- MCOs like TCHP must reprocess affected claims submitted with these procedure codes and date of service on or after June 25, 2025.
- Providers are not required to appeal the claims unless they are denied for additional reasons after the claims reprocessing is complete.
- Providers may bill MCOs like TCHP retroactively for procedure code 90679 and 90683 for members 50 years of age or older.
Next step for Providers: Providers should share this information 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.