Texas Health and Human Services Commission

TEXAS HEALTH AND HUMAN SERVICES COMMISSION

THOMAS M. SUEHS March 31, 2011 EXECUTIVE COMMISSIONER

Laura Blanke, MPH Texas Pediatric Society, Practice Education Manager 401 W. 15th St., Ste. 682 Austin, TX 78701

Dear Ms. Blanke:

We have researched your request for clarification, in consultation with our legal experts, regarding the type of provider that fits the definition of “other qualified health care professional” included in the immunization administration codes 90460 and 90461. The following constitutes Texas Medicaid Office of the Medical Director’ interpretation:

At the nursing level, the counseling may be provided by an advanced nurse practitioner. Nurse practitioners, termed advance practice registered nurses, certified nurse-midwives, and clinical nurse specialists do meet the criteria for provision of the counseling benefit related to immunizations. However, registered nurses (without advanced education and credentials), licensed vocational nurses, or medical assistants do not meet the criteria for provision of the counseling benefit related to immunizations in any section of any applicable Texas rule or law. Texas licensing law for these occupations is consistent across all reviewed areas and does not allow for these parties to provide or bill for the counseling related to drug/vaccine administration.

On February 11, 2011, the State’s claims administrator, Texas Medicaid Healthcare Partnership (TMHP), issued an Information Posting entitled “Immunization Administration Procedure Code Changes Effective April 1, 2011”. The Information Posting is accurate.

Sincerely,

Jose J. Gonzalez, M.D., J.D., M.S.Ed. Medical Director, Texas Medicaid/CHIP

HHSC Medical & UR Appeals, H-230 PO Box 85200 Austin, Texas 78708-5200 Telephone: 512-491-1118