MedicaidBilling CodesMedium impact
MAB2023053001
Pennsylvania Medicaid (DHS)·PA · Pediatrics, Family Medicine, General Practice·Provider Bulletin
Effective date
Jun 12, 2023
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid is adding new procedure code G0312 for vaccine counseling-only visits (without vaccine administration) for patients under 21, replacing the previous 99401+U1 modifier combination. The new code pays $10.00 and can be billed once per day.
Action Required
By June 12, 2023: Billing team must update Pennsylvania Medicaid billing to use new code G0312 ($10.00) for vaccine counseling-only visits for patients under 21. Stop using 99401 with U1 modifier after June 11, 2023. Update billing system to limit G0312 to once per day and ensure it's not billed with complete EPSDT screens. Code can be used with telemedicine (POS 02, 10).