SPECIAL BULLETIN COVID-19 #240: Update on Vaccination Counseling Code Reimbursement Coverage date has been extended from March 31, 2022, to the end of the federal Public Health Emergency

This bulletin is an update to COVID-19 Bulletin #184.

This update provides information extending vaccination counseling coverage date from March 31, 2022, to the end of the federal Public Health Emergency (PHE).

NC Medicaid recognizes the importance of vaccinating Medicaid beneficiaries against COVID-19. We also understand the additional administrative responsibilities COVID-19 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 PHE.

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.  

Note: COVID Counseling is available for all NC Medicaid beneficiaries, both Medicaid Direct and Medicaid Managed Care.

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 can be provided to an individual beneficiary. Counseling may be provided in person, through live audio/video (telehealth) or telephonically. Additionally, this service can be billed by multiple providers and can be billed multiple times on different days.

Providers must bill CPT 99401 with a CR modifier to indicate a PHE code. There is no requirement for a specific diagnosis code. The following coding criteria will apply:

  • Requires 25 modifier if in addition to OV E&M, if applicable
  • Requires CR and GT modifiers if provided via telehealth
  • Requires CR and KX modifiers if provided telephonically

Providers are encouraged to counsel Medicaid beneficiaries of any age. Parents can be counseled about giving the vaccine to their children age 12 and over. 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, but only one code can be billed per day.

The service can only be provided by MD/DO, NP, PA, CNM and, if provided at LHD, FQHC or RHC by one of these professionals, will be reimbursed outside of the PPS rate. Reimbursement is based on relative value units (RVU) and ranges from $20.68 – $24.54 for Facility and from $32.28 – $38.30 for Non-Facility. The coverage is time-limited and was set to end on March 31, 2022, but coverage has been extended through the end of the Federal PHE for all NC Medicaid beneficiaries (Medicaid Direct and Medicaid Managed Care). For more information on the rates, please refer to the applicable Fee Schedule listed below.

CONTACT

NCTRACKS Contact Center: 800-688-6696

This blog is related to:

https://medicaid.ncdhhs.gov/blog/2022/03/24/special-bulletin-covid-19-240-update-vaccination-counseling-code-reimbursement