MedicaidCoverageMedium impact
COVID-19 Counseling for Pediatric Patients
Maryland Medicaid·MD · Pediatrics, Family Medicine, Internal Medicine +1 more·Provider Transmittal
Effective date
Jan 1, 2022
We identified it
Jun 20, 2026
Summary
Maryland Medicaid now reimburses providers for COVID-19 vaccination counseling for pediatric patients (ages 20 and under) using CPT 99401 with CR modifier at FFS rates ($26.10 facility / $42.41 non-facility). Counseling can be provided in-person or via telehealth and is reimbursable once per date of service with no visit limit. This benefit is available through the last day of Q1, one year after the COVID-19 public health emergency ends.
Action Required
By January 31, 2022: Billing team must update billing software to recognize CPT 99401 with CR modifier for COVID-19 counseling claims on Maryland Medicaid patients ages 20 and under. Configure billing rules to apply facility rate ($26.10) and non-facility rate ($42.41) appropriately. When telehealth delivery is used, ensure GT/UB modifiers are added alongside CR modifier. Providers must document whether counseling was provided to the pediatric patient directly or to parents/guardians on the child's behalf, and bill using the child's Medical Assistance number. For FQHCs and RHCs, add CR modifier to billing templates and ensure this service is only reimbursed at FFS rate when it is the sole purpose of the visit; otherwise it is bundled into the cost-based visit rate. Failure to implement correct coding and modifiers will result in claim denials.