Here's how to get reimbursed for COVID vaccine counseling

Health care providers can bill and be reimbursed for COVID-19 vaccine counseling in addition to vaccine administration.

Private Insurance

  • Bill using diagnosis code Z71.89 and CPT code 99401, 99441 or 98966
  • Consultation is by an in-network medical provider (does not include pharmacy services providers)
  • Provider must have established relationship with patient
  • Cap of two billings per patient

Medicaid

  • Vaccine counseling is covered for both new and established clients
  • Providers can bill in the following ways (Please review AMA CPT ® guidelines for code guidance):
    • If the patient is prescheduled for a visit and counseling is then added, the provider may choose the appropriate E/M level
    • The provider may bill 99401 using modifier 25 in addition to billing EM visit; the E/M visit in this case should not include the time spent on COVID counseling
    • The provider may bill 99401 individually, if no E/M visit occurred and COVID vaccine counseling was provided
  • Nurses and medical assistants who counsel patients can bill using CPT® code 99211
  • For further details on billing for Medicaid clients please review the WA Medicaid COVID-19 Vaccine Clinical Policy

We encourage health care professionals performing counseling visits to be prepared to provide vaccine or refer to appropriate, accessible vaccine sites to the patient.