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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 © 2022 American Dental Association (or such other date publication of CPT and
CDT). All rights reserved. Applicable FARS/DFARS apply.