What insurance policy changes affect HCPCS G0310?

There are 5 tracked policy changes affecting HCPCS G0310, including updates from Aetna, NC Medicaid - NCDHHS. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for HCPCS G0310?

Payers that have issued tracked updates for HCPCS G0310 include: Aetna, NC Medicaid - NCDHHS.

How do I get notified when HCPCS G0310 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to HCPCS G0310. You will receive a daily digest email whenever a new policy change references this code.

Why do payers change policies for HCPCS G0310?

Payers revise policies for individual billing codes to align with updated clinical guidelines, CMS rule changes, fraud and abuse prevention measures, or network cost-management goals. Changes can affect medical necessity criteria, place-of-service restrictions, bundling rules, or whether a code requires prior authorization.

G0310 — Immunization counseling by a physician or other qualified health care professional when the vaccine(s) is not administered on the same date of service, 5 to 15 mins time (this code is used for medicaid billing purposes): Insurance Policy Changes

G0310 Insurance Policy Changes

HCPCS G0310 is officially defined as "Immunization counseling by a physician or other qualified health care professional when the vaccine(s) is not administered on the same date of service, 5 to 15 mins time (this code is used for medicaid billing purposes)." HCPCS G0310 is referenced in 5 tracked payer policy changes from Aetna and NC Medicaid - NCDHHS. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for HCPCS G0310 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

High impact

NC Medicaid COVID-19 Vaccine Guidelines for 2026-2027

NC Medicaid - NCDHHS·Identified Oct 13, 2026

NC Medicaid updated its 2026-2027 COVID-19 vaccine coverage guidelines, introducing new vaccine formulations (targeting JN.1/LP.8.1 lineages) with updated NDC codes, CPT codes, and age-specific coverage criteria. Key billing changes include mandatory use of new vaccine CPT codes (91319, 91320, 91321, 91322, 91323, 91304), updated ICD-10 code Z23, new HCPCS counseling codes (G0310, G0312, G0315) effective since October 1, 2024, and pharmacy reimbursement for COVID-19 vaccines at point-of-sale for beneficiaries ages 3 and older effective January 1, 2025. The CG modifier must be appended to all COVID-19 vaccine and administration claims submitted by pharmacies, and the EP modifier applies to beneficiaries under age 21.

G0310 Insurance Policy Changes

Pneumococcal Vaccines (CPB 0037, reviewed 2026-03-02)

NC Medicaid COVID-19 Vaccine Guidelines for 2026-2027

Dengue Vaccine (CPB 1010, reviewed 2026-02-25)

Influenza Vaccines (CPB 0035, reviewed 2026-10-08)

Pneumococcal Vaccines (CPB 0037, reviewed 2026-10-06)