NC Medicaid recognizes the importance of vaccinating Medicaid beneficiaries for COVID-19 and data suggests that Medicaid beneficiaries have received vaccines at a much lower rate than the state average. We understand the additional administrative burden this places on Medicaid providers related to stocking the vaccine, the additional time it takes for counseling and informed consent, entering the data as required and the impact on workflow of post-vaccine observation. We also understand that providers would like to be able to conduct outreach efforts beyond in-office counseling and want to support that work.
Effective Oct. 22, 2021, NC Medicaid-enrolled providers can bill code 99401 with HM modifier for telephone outreach to unvaccinated Medicaid beneficiaries. The goal of the outreach is to educate the beneficiaries on the vaccine and assist them in scheduling an appointment, ideally in the office where the outreach is originated.
- CPT 99401 HM has a limit of one call per beneficiary per day. The code can only be billed for successfully connecting with the beneficiary; hangups or voicemails cannot be billed.
- Medicaid-enrolled providers must bill CPT 99401 HM with a CR modifier to indicate a PHE code.
- There is no requirement for a specific diagnosis code associated with the code.
Providers are encouraged to counsel Medicaid beneficiaries following CDC guidance for qualifying for vaccination. 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 (99401) for the parent or guardian can be billed to the child’s Medicaid ID, but only one code can be billed per day per ID (see SPECIAL BULLETIN COVID-19 #184 for complete details).
This outreach service can be provided by members of the office staff of the MD/DO, NP, PA or CNM and if provided at LHD, FQHC or RHC will be reimbursed outside of the PPS rate. The NPI of the provider present at the office will be the rendering provider on the claim.
NCTracks Call Center: 800-688-6696