MedicaidBilling CodesMedium impact
BT2022108: IHCP revises billing guidance for pediatric vaccine counseling services
Indiana Medicaid (IHCP)·IN · Family Medicine, Pediatrics, Internal Medicine·Claims & Billing
Effective date
Jan 6, 2023
We identified it
Jun 19, 2026
Summary
Indiana Medicaid (IHCP) has revised billing guidance for pediatric vaccine counseling services to comply with the American Rescue Plan Act. Stand-alone vaccine counseling codes G0312 and G0313 must now be billed as EPSDT services for patients under 21, while all vaccine counseling codes can only be billed in professional settings, not outpatient facilities with revenue code 636.
Action Required
By January 6, 2023: Billing team must update system to bill G0312 and G0313 as EPSDT services for patients under 21 with diagnosis codes Z00.121 or Z00.129 only. Remove revenue code 636 linkage from all vaccine counseling codes G0310, G0311, G0312, and G0313 - these can only be billed on professional claims. Update encounter forms to reflect professional setting requirement and EPSDT billing for pediatric patients. Claims will be denied if billed incorrectly in outpatient settings.