Provider Reimbursement for COVID-19 Vaccine Counseling

Sept. 13, 2021 Update: This communication has been reposted for further awareness. The original communication was posted on August 27, 2021.

This notice is a clarification of the appropriate coding for provider reimbursement for COVID-19 vaccine counseling (CPT 99401) for vaccine-hesitant commercial members. This update is not a change in coverage, but rather provides details for providers as to how the service should be billed. Please note that this applies only to commercial membership. CPT 99401 is not covered for Medicare Advantage members. Please see messaging below.  

Key Details:

• CPT 99401: Preventative medicine counseling and/or risk factor reduction intervention(s) provided to an individual, up to 15 minutes may be used to counsel commercial members regarding the benefits of receiving the COVID-19 vaccine.   
  
• CPT 99401 can be billed at only one visit for each member per day, but there are not quantity limits for the number of times this education is provided to an individual member.   
• Providers may bill CPT 99401 with ICD-10 code Z71.89 for no member cost-share.  
• Providers are encouraged to counsel all members who have not yet received their COVID-19 vaccination.  
• This service can be provided by MD/DO, NP, PA, and/or CNM. 

For more information, click here to view the special bulletin from the North Carolina Department of Health and Human Services.