CMS creates new codes for stand-alone vaccine counseling

The Centers for Medicare & Medicaid Services (CMS) released HCPCS codes for vaccine counseling this week. The codes are to be used when a physician counsels a patient about receiving a recommended vaccine and the patient (or patient’s parent or other health care agent) chooses not to have the vaccine administered that day.

In a letter to the states, CMS officials said physicians and other health care clinicians may use the codes to bill for “stand-alone vaccine counseling,” including COVID-19 vaccine counseling provided to Medicaid and Children’s Health Insurance Program (CHIP) beneficiaries who are eligible for coverage as required by the American Rescue Plan and the Medicaid Early and Periodic Screening, Diagnosis and Treatment (EPSDT) provisions.

CMS is allowing the codes to be used for vaccine counseling provided via telehealth as well as in person, but states can decide whether to cover these services via telehealth for Medicaid EPSDT. CMS also said that in this case, “stand-alone” counseling only means that the vaccine discussed is not administered at that visit. The codes may be used for visits that include other services.

G0310 - Immunization counseling by a physician or other qualified health care professional when the vaccine(s) is not administered on the same date of service, 5-15 minutes. (This code is used for Medicaid billing purposes.)    

G0311 - Immunization counseling by a physician or other qualified health care professional when the vaccine(s) is not administered on the same date of service, 16-30 minutes. (This code is used for Medicaid billing purposes.)    

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, 5-15 minutes. (This code is used for Medicaid billing purposes.)    

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 minutes. (This code is used for Medicaid billing purposes.)    

G0314 - Immunization counseling by a physician or other qualified health care professional for COVID-19, ages under 21, 16-30 minutes. (This code is used for the Medicaid EPSDT benefit).

G0315 - Immunization counseling by a physician or other qualified health care professional for COVID-19, ages under 21, 5-15 minutes. (This code is used for the Medicaid EPSDT benefit).        

CMS officials noted that Medicaid beneficiaries have some of the lowest COVID-19 vaccination rates among patients for whom COVID shots are recommended and that vaccination rates for other shots have also fallen for Medicaid beneficiaries during the pandemic. The agency wrote that the counseling represented by the new codes “has been shown to help address vaccine hesitancy by helping beneficiaries and their families learn about vaccines from trusted health care providers.”

— Kent Moore, senior strategist for physician payment, American Academy of Family Physicians

Posted on June 13, 2022, by Kent Moore