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TO:   Vaccine Providers

RE:   Billing for Vaccine Counseling to Recipients Under Age 21

As a part of the EPSDT benefit for recipients under age 21, effective April 1, 2021, Medicaid will cover the following procedure codes for vaccine counseling for recipients under age 21 when billed in conjunction with a well-child visit (EPSDT periodic or interperiodic screening), whether a vaccine is or is not administered on the same day:

When is it appropriate to bill CPT 99401, 90460 or 90461?

A provider should appropriately bill these codes when providing vaccine counseling to a recipient under age 21. CPT 90460 and 90461 should not be billed on the same day as procedure codes for counseling or vaccine administration only in conjunction with the well-child visit.

Are modifiers required?

Providers should include modifiers EP and 25 when billing one of the above procedure codes with a well-child visit on the same day of service.

For questions, please visit www.medicaid.alabama.gov or call the Medicaid Fiscal Agent at 1-800-688-7989.

The Current Procedural Terminology (CPT) and Current Dental Terminology (CDT) codes descriptors, and other data are copyright © 2017 American Medical Association and © 2017 American Dental Association (or such other date publication of CPT and CDT). All rights reserved. Applicable FARS/DFARS apply.