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