MedicaidBilling CodesMedium impact
MAB2022092001
Pennsylvania Medicaid (DHS)·PA · Family Medicine, Pediatrics, General Practice +1 more·Provider Bulletin
Effective date
Sep 20, 2022
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance (Medicaid) now covers vaccine counseling visits for beneficiaries under 21 when no vaccine is administered. Providers can bill CPT 99401 with modifier U1 at $10.00 for up to 15 minutes of counseling, limited to once per day.
Action Required
Immediately: Billing team must add CPT 99401 with modifier U1 to billing system for Pennsylvania Medicaid vaccine counseling visits (beneficiaries under 21, no vaccine given). Set reimbursement at $10.00, limit once per day. Cannot be billed with complete EPSDT screens. Update encounter forms for eligible provider types (physicians, NPs, CNMs, PAs, hospital/clinic staff).