Vaccine Counseling Reimbursement Update

Hello POP Members,

In this edition of our email series we wanted to highlight the importance of one our key POP Initiative tenants, Ask/Education. 

People are exposed to a tremendous amount of information about COVID-19 and COVID-19 vaccine, through social media, television, and word of mouth.  It can be hard a lot of people to know what to believe, but as trusted sources of medical information you can help.                                        

 

                                               

 

Conversations with patients addressing misconceptions, concerns or hesitation about vaccination may qualify as vaccine counseling and be reimbursable.  You may get reimbursed for conversations on other vaccine-related topics such as:

• Patient’s reasons for not being vaccinated
• Providing tailored and individualized medical advice regarding COVID-19 vaccine for that patient
• Providing resources about how to get a COVID-19 vaccine

Contact insurers directly for instructions and amounts. Each carrier will have specific guidance for billing and coverage. Below is a summary from the emergency order requiring coverage for vaccine counseling and the Medicaid policy.   

Private Insurance

• Bill using diagnosis code Z71.89 and CPT code 99401, 99441 or 98966
• Consultation is by an in-network medical provider (does not include pharmacy services providers)
• Provider must have established relationship with patient
• Cap of two billings per patient 

Medicaid

• Vaccine counseling is covered for both new and established clients
• Providers can bill in the following ways:  (Please review AMA CPT ® guidelines for code guidance) 
  • If the patient is prescheduled for a visit and counseling is then added, the provider may choose the appropriate E/M level
  • The provider may bill 99401 using modifier 25 in addition to billing EM visit; the E/M visit in this case should not include the time spent on COVID counseling
  • The provider may bill 99401 individually, if no E/M visit occurred and COVID vaccine counseling was provided
• Nurses/medical assistants nurses and medical assistants who counsel patients can bill using CPT® code 99211
• For further details on billing for Medicaid clients please review the WA Medicaid COVID-19 Vaccine Clinical Policy 

 

You can also find additional details about COVID-19 vaccine billing and reimbursement in these slides and Q & A document.

 

Thank you for your continued efforts in helping to protect the health and wellbeing of Washingtonians!                                           

Power of Providers Team

Prevention and Community Health Division

Washington State Department of Health

powerofprovider@doh.wa.gov

360-236-3873 | www.doh.wa.gov/pop