MedicaidBilling CodesMedium impact
MAB2023053002
Pennsylvania Medicaid (DHS)·PA · Family Medicine, Pediatrics, Internal Medicine +1 more·Provider Bulletin
Effective date
Jun 12, 2023
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid is transitioning COVID-19 vaccine counseling billing for patients under 21 from CPT 99401 with U2 modifier to new HCPCS code G0315, reimbursed at $10.00. The old code will be discontinued effective June 11, 2023.
Action Required
By June 11, 2023: Billing team must stop using CPT 99401 with U2 modifier for COVID-19 vaccine counseling visits for patients under 21. Starting June 12, 2023: Use new HCPCS code G0315 instead, which reimburses at $10.00 and is limited to once per day. Update billing system and encounter forms to reflect this code change. This applies only to counseling visits where no vaccine is administered.