New York
Provider Communications
Provider reimbursement for Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Counseling program
|
CPT® code |
Fee |
Notes |
Claims based |
CPT 99401 DX: Z71.85 |
$12.50 |
A provider submitting professional claims should bill Current Procedure Terminology (CPT) code 99401 for preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure) for reimbursement for childhood vaccine counseling. A minimum of eight minutes is required and recommended for ages 18 years or younger. |
Key details — The childhood vaccine counseling session must be documented in the medical or pharmacy record and must include the following:
- CPT 99402: Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure).
- Providers should bill CPT 99402 with ICD-10 code Z71.85.
- Confirm vaccination status in the New York State Immunization Information System (NYSIIS) or City Immunization Registry (CIR), whenever possible.
- Providers are encouraged to counsel all members who have not already have an appointment scheduled to receive the vaccine dose for which they are being counseled.
- For more information, visit https://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html
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