November 3, 2022

State of Alabama
Press Release: Medicaid

UPDATE – Billing for Stand-alone Vaccine Counseling to Recipients Under Age 21

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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 Vaccine Counseling to Recipients Under Age 21

 

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

 

Effective May 11, 2022, Medicaid will cover the following procedure codes, G0312 and G0313, for stand-alone vaccine counseling as part of the EPSDT benefit for recipients under 21 years of age.

 

Stand-alone Vaccine Counseling Codes

Procedure Code

Procedure Code Description

Rate

G0312

Immunization counseling by a physician or other qualified health care professional when the vaccine(s) is not administered on the same date of service for ages under 21, 5 to 15 mins time.

$13.00                 

G0313

Immunization counseling by a physician or other qualified health care professional when the vaccine(s) is not administered on the same date of service for ages under 21, 16-30 mins time.

$13.00

 

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

 

When is it appropriate to bill procedure code G0312 or G0313?

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

 

Can procedure codes G0312 and G0313 be billed in conjuncture with CPT 99401, 90460, or 90461?

No, procedure codes G0312 and G0313 CANNOT be billed in conjuncture with CPT 99401, 90460, or 90461.

 

Are modifiers required?

Modifiers are not required for procedure codes G0312 or G0313 with an office visit on the same day of service.

 

How should Pharmacy provider bills 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 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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