Effective for dates of service on or after November 2, 2021, the Indiana Health Coverage Programs (IHCP) will reimburse providers for providing COVID-19 vaccine information and/or education to members.
The IHCP will cover procedure code 99401 – Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 15 minutes.
Code 99401 is reimbursable even if a member decides against vaccination after receiving counseling. CPT code 99401 is restricted to one unit per day, per unvaccinated member, per provider. When billing, providers must include modifier 25 – Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service, or the claim detail will deny.
Coverage applies to managed care claims for COVID-19 vaccine counseling, billed on professional claims (CMS-1500 claim form, IHCP Provider Healthcare Portal [Portal] professional claim or 837P electronic transaction) and outpatient claims (UB-04 claim form, Portal institutional claim or 837I electronic transactions) with a date of service on or after November 2, 2021.
Coverage applies to all Traditional Medicaid and other IHCP programs that include full Medicaid State Plan benefits including:
CPT code 99401 with modifier 25 can only be billed for COVID-19 counseling in the unvaccinated eligible member population (ages 6 months and up).
COVID-19 vaccination counseling is separately reimbursable from the COVID-19 vaccine. Providers are encouraged to vaccinate members after the counseling session when applicable. Providers are also encouraged to provide any additional vaccines during the same encounter.
For answers to specific questions, call Provider Services at 877-610-9785.