November 3, 2022

State of Alabama
Press Release: Medicaid

UPDATE - Billing for Stand-alone COVID-19 Vaccine Counseling for Recipients Under Age 21

PDF Version 

TO:  Hospital Providers, Physicians, Nurse Practitioners, Physician Assistants, Pharmacies, County Health Departments, Federally Qualified Health Centers, and Rural Health Clinics

 

RE: UPDATE - Billing for Stand-alone COVID-19 Vaccine Counseling for Recipients Under Age 21

Information in this Provider ALERT is in coordination with the ALERTs published April 13, 2022. 


Effective May 11, 2022, through a time indicated by the Alabama Medicaid Agency (Medicaid), Medicaid will cover the following procedure codes for stand-alone COVID- 19 vaccine counseling for recipients under 21 years of age:


 

Stand-alone Vaccine Counseling Codes

Procedure Code

Procedure Code Description

Rate

G0314

Immunization counseling by a physician or other qualified health care professional for COVID-19, ages under 21, 16-30 mins time.

 

$31.70

G0315

Immunization counseling by a physician or other qualified health care professional for COVID-19, ages under 21, 5-15 mins time.

 

$31.70

 

For dates of service prior to May 11, 2022, please refer to the ALERT “Billing for COVID-19 Vaccine Counseling for Recipients under Age 21” dated April 13, 2022. 

 

When will the rate of $31.70 end?

At such time Medicaid indicates through a subsequent Provider ALERT.

 

When is it appropriate to bill procedure code G0314 or G0315?

A provider should appropriately bill these codes when ONLY providing COVID-19 vaccine counseling to a recipient under age 21, and the recipient does NOT receive a COVID vaccine on the day of service.

 

Can procedure codes G0314 and G0315 be billed in conjuncture with CPT 99401 and modifiers CR and 25?

No, procedure codes G0314 and G0315 CANNOT be billed in conjuncture with CPT 99401 and modifiers CR and 25.

 

Are modifiers required?

Modifiers are not required for procedure codes G0314 or G0315 with an office visit on the same day of service.

 

How should Pharmacy providers bill for these procedure codes? 

Pharmacy providers must bill under their DME NPI, as these codes are not applicable under the NCPDP billing system. 

 

Providers with billing questions may visit http://www.medicaid.alabama.gov or contact the Gainwell Technology Provider Assistance Center at 1-800-688-7989.


The Current Procedural Terminology (CPT) and Current Dental Terminology (CDT) codes descriptors, and other data are copyright © 2022 American Medical Association
and © 20
22 American Dental Association (or such other date publication of CPT and CDT). All rights reserved. Applicable FARS/DFARS apply.

 



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