MedicaidCoverageMedium impact
BT202278: IHCP expands stand-alone COVID-19 vaccine counseling for EPSDT-eligible members
Indiana Medicaid (IHCP)·IN · Family Medicine, Pediatrics·Specialty Services
Effective date
Oct 20, 2022
We identified it
Jun 19, 2026
Summary
Indiana Health Coverage Programs (IHCP) will reimburse pharmacies for stand-alone COVID-19 vaccine counseling sessions for EPSDT-eligible members starting October 20, 2022. Pharmacies can bill up to 4 counseling sessions per member annually at $28.92 per session using specific NCPDP codes, but cannot bill for both counseling and vaccine administration for the same visit.
Action Required
By October 20, 2022: Pharmacies must update their point-of-sale systems to submit COVID-19 vaccine counseling claims using HCPCS code 99429 with specific NCPDP D.0 format requirements including BIN 001553, processor control number INM, and reimbursement amount $28.92. Document all counseling sessions with required elements including 15-minute minimum duration, CHIRP verification, and member consent. Do not bill for both counseling and vaccine administration on the same visit.