MedicaidBilling CodesMedium impact
June 2026 TMPPM Update for Vaccine Services Procedure Code 90461
Texas Medicaid·TX · Family Medicine, Pediatrics, Internal Medicine +1 more·Coding
Effective date
Jun 1, 2026
We identified it
May 30, 2026
Summary
Effective June 1, 2026, Texas Medicaid clarifies that procedure code 90461 should be used for administering additional vaccine components, but will NOT reimburse this code when vaccines are eligible under the Texas Vaccines for Children (TVFC) programs. This creates a billing restriction for TVFC-eligible vaccines.
Action Required
By June 1, 2026: Billing team must update system to block reimbursement claims for CPT 90461 when administering vaccines eligible under Texas Vaccines for Children (TVFC) programs. Update encounter forms and train staff to identify TVFC-eligible vaccines before billing 90461. Continue using 90461 only for additional vaccine components from non-TVFC vaccines to avoid claim denials.