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TO:   Vaccine Providers

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

Effective April 1, 2021, through a time indicated by the Alabama Medicaid Agency (Medicaid), Medicaid will cover the following procedure codes for COVID-19 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 will the rate of $31.70 end?

At such time Medicaid indicates through a subsequent Provider ALERT.

When is it appropriate to bill CPT 99401?

A provider should bill this code when providing vaccine counseling to a recipient under age 21 for a COVID-19 vaccine.

Are modifiers required?

Provider should include modifiers CR and 25 when billing CPT 99401 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 © 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.