MedicaidBilling CodesMedium impact
Childhood Vaccine Counseling
NY Medicaid·NY · Pediatrics, Family Medicine, General Practice +1 more·Provider Bulletin
Effective date
Apr 1, 2026
We identified it
Jun 30, 2026
Summary
Effective April 1, 2026, NYS Medicaid (FFS and MMC) will reimburse childhood vaccine counseling using CPT 90483 when counseling is provided without vaccine administration on the same date, and CPT 99401 when counseling occurs with simultaneous vaccine administration. Billing teams must implement code selection logic based on same-day vaccine administration and ensure proper documentation in medical records.
Action Required
By April 1, 2026: Billing team must update billing system logic to select CPT 99401 when vaccine counseling and administration occur on the same date of service, and CPT 90483 when counseling is provided without same-day vaccine administration. Ensure encounter forms and templates prompt providers to clearly document (1) whether vaccine was administered same-day, (2) counseling duration (minimum 8 minutes for 99401; 10-20 minutes for 90483), (3) alignment with recommended immunization schedules, and (4) medical record documentation of counseling provided. Configure system to limit reimbursement to 6 counseling visits per member per year for members without recommended doses. Providers must verify current reimbursement rates on eMedNY Provider Manuals before implementation. Failure to use correct code based on same-day administration will result in claim denials.