Strategy
The North Carolina Department of Health and Human Services and NC Medicaid partnered to find a solution that would allow pediatric providers to be reimbursed for COVID-19 vaccine counseling for Medicaid beneficiaries.
Challenge
Pediatric providers are a strong source of knowledge regarding child vaccinations. The COVID-19 pandemic necessitated conversations between families and providers about whether their child should be vaccinated. Such conversations are serious and can take time. North Carolina did not have an existing funding mechanism to compensate pediatric providers for having these conversations with Medicaid or BlueCross BlueShield recipients.
Solution
North Carolina’s state Medicaid program expanded use of Current Procedural Terminology (CPT) 99401: Preventative medicine counseling and/or risk factor reduction intervention code on June 22, 2021, for providers to charge time spent talking to families about COVID-19 vaccination. Making this time reimbursable was intended to encourage vaccine access for North Carolinians by increasing provider capacity for counseling and post-vaccine observation. The charge code could be used for 15 minutes per beneficiary visit, per day. There was no limit on the total amount of time charged per beneficiary across multiple days. Counseling could be administered either in-person or virtually and was not limited to specific age groups. Parents of children enrolled in Medicaid could receive counseling regardless of their own Medicaid enrollment status. Charge code usage for Medicaid beneficiaries was extended until the end of the public health emergency, despite initial budgeting for only three months.
Outcome
Providers accepting Medicaid could now bill time spent counseling patients, increasing capacity and willingness to provide this service. Following suit, BlueCross BlueShield of North Carolina opened this code to providers serving its beneficiaries on August 27, 2021.
Supplemental Resources