SPECIAL BULLETIN COVID-19 #168: Vaccination Counseling Code Reimbursement

This Bulletin was updated on July 9, 2021, in SPECIAL BULLETIN COVID-19 #170.

NC Medicaid recognizes the importance of vaccinating Medicaid beneficiaries for COVID-19. We also understand the additional administrative burden this places on Medicaid providers due to providing the vaccine in your offices and the additional time it takes for counseling and informed consent, as well as post-vaccine observation. NC Medicaid reimburses for the provision of the vaccine at the same rate as Medicare and is creating an additional payment to encourage access to vaccines during the Public Health Emergency. 

Effective June 22, 2021, CPT 99401: Preventative medicine counseling and/or risk factor reduction intervention (s) provided to an individual, up to 15 minutes has been added to counsel Medicaid beneficiaries regarding the benefits of receiving the COVID-19 vaccine.  

CPT 99401 can be billed at only one visit for each beneficiary per day, but there are not quantity limits for the number of times this education is provided to an individual beneficiary.  

Providers must bill CPT 99401 with a CR modifier and there is no requirement for a specific diagnosis code.

Providers are encouraged to counsel Medicaid beneficiaries of any age. Parents or guardians of Medicaid children can be counseled on the benefit of receiving the COVID-19 vaccination even if the parent or guardian is not enrolled in NC Medicaid. The counseling session for the parent or guardian can be billed to the child’s Medicaid ID. 

This service can be provided by MD/DO, NP, PA, CNM and if provided at LHD, FQHC or RHC will be reimbursed outside of the PPS rate. 

Contact:

NCTracks Call Center: 800-688-6696