Influenza Vaccine Procedure Code 90653 to Become a Benefit of Texas Medicaid

Date: September 26, 2024
Attention: All Providers
Effective date: September 1, 2024

Call to action: Texas Children Health Plan (TCHP) would like to inform providers that effective for dates of service on or after September 1, 2024, influenza vaccine procedure code 90653 will become a benefit of Texas Medicaid for individuals 65 years of age or older.

With ongoing cases of highly contagious respiratory illnesses, it is important to remind patients to protect themselves and their families by getting routine vaccinations. This can help keep our members well and prevent unnecessary medical visits or hospitalizations that continue to put a strain in our healthcare systems. Getting vaccinated for the flu can prevent the spread of the virus.

How this impacts providers: Procedure code 90653 may be reimbursed 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), Nephrology (Hemodialysis, Renal Dialysis), Pharmacy
Home	Physician, CCP
Outpatient Hospital	Hospital, Nephrology (Hemodialysis, Renal Dialysis), Renal Dialysis Facility
Other Locations	Physician, Physician Assistant, Nurse Practitioner, Clinical Nurse Specialist, CCP

Administration for procedure code 90653 may be reimbursed when billed with corresponding vaccine administration procedure code 90471 or 90472.

Next step for Providers: Providers are encouraged to 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,log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.