NOTICES
DEPARTMENT OF
HUMAN SERVICES
Medical Assistance Program Fee Schedule Updates for EPSDT and COVID-19 Vaccine Counseling Only Visits
[53 Pa.B. 2917]
[Saturday, May 27, 2023]In accordance with 55 Pa. Code § 1150.61(a) (relating to guidelines for fee schedule changes), the Department of Human Services (Department) announces the addition of procedure codes G0312 and G0315 to the Medical Assistance (MA) Program Fee Schedule for Early and Periodic Screening, Diagnostic and Treatment (EPSDT) and novel coronavirus (COVID-19) vaccine counseling only visits, respectively, when provided to MA beneficiaries under 21 years of age or their parent or caregiver, or both, and no EPSDT pediatric vaccine or SARS-CoV-2 vaccine, respectively, is administered.
Background
The Department added procedure code 99401 with the U1 modifier to the MA Program Fee Schedule on September 20, 2022, to bill for EPSDT vaccine counseling only visits provided to MA beneficiaries under 21 years of age or their parent or caregiver, or both, that receive counseling about any pediatric vaccine covered under the EPSDT benefit, but no pediatric vaccine is administered.
The Department added procedure code 99401 with the U2 modifier to the MA Program Fee Schedule on September 23, 2022, to bill for COVID-19 vaccine counseling only visits provided to MA beneficiaries under 21 years of age or their parent or caregiver, or both, when a SARS-CoV-2 vaccine is not administered.
The Centers for Medicare & Medicaid Services developed new procedures, G0312 and G0315, to bill for EPSDT and COVID-19 vaccine counseling only visits, respectively, for MA beneficiaries under 21 years of age. Although states are not required to utilize these procedure codes, the Department is adding them to the MA Program Fee Schedule.
Procedure Code Being Added
The Department is adding the following procedure codes, procedure code descriptions and MA fees to the MA Program Fee Schedule, effective with dates of service on and after June 12, 2023:
Procedure
CodeCode Description Fee 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 under 21 years of age, 5—15 minutes time (This code is used for Medicaid billing purposes) $10 G0315 Immunization counseling by a physician or other qualified health care professional for COVID-19, under 21 years of age, 5—15 minutes time (This code is used for the Medicaid Early and Periodic Screening, Diagnostic and Treatment Benefit (EPSDT)) $10 Procedure Codes Being End-Dated
Effective with dates of service on and after June 11, 2023, the MA Program is end-dating procedure code 99401 with the U1 modifier for the provision of vaccine counseling only visits to MA beneficiaries under 21 years of age for pediatric vaccine provided through the EPSDT benefit when no pediatric vaccines are administered.
Additionally, effective with dates of service on and after June 11, 2023, the MA Program is end-dating procedure code 99401 with the U2 modifier for the provision of COVID-19 vaccine counseling only visits for beneficiaries under 21 years of age when a SARS-CoV-2 vaccine is administered.
The MA Program Fee Schedule has been updated to reflect these changes.
Fiscal Impact
There is no fiscal impact associated with the addition of these procedure codes.
Public Comment
Interested persons are invited to submit written comments regarding this notice to the Department of Human Services, Office of Medical Assistance Programs, c/o Regulations Coordinator, P.O. Box 2675, Harrisburg, PA 17120, RA-PWMAProgComments@pa.gov. Comments received within 30 days will be reviewed and considered for any subsequent revision of the MA Program Fee Schedule.
Persons with a disability who require an auxiliary aid or service may submit comments using the Pennsylvania Hamilton Relay Service (800) 654-5984 (TDD users) or (800) 654-5988 (voice users).
VALERIE A. ARKOOSH,
Acting SecretaryFiscal Note: 14-NOT-1578. No fiscal impact; recommends adoption.
[Pa.B. Doc. No. 23-703. Filed for public inspection May 26, 2023, 9:00 a.m.]
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