Flu Season Alert!Alerta de temporada de influenza:
Don’t let germs win this season – protect yourself and your family!
The flu vaccine is your best defense against flu and related complications – PLUS, it is a covered benefit for Texas Children’s Health Plan members! Learn more!
¡No permitas que los gérmenes ganen esta temporada! ¡Protégete a ti y a tu familia!
La vacuna contra la influenza es tu mejor defensa contra la influenza y sus complicaciones. Además, ¡es un beneficio cubierto para los miembros de Texas Children's Health Plan! Aprende más
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.
