HCA and OIC provide vaccine counseling payment information

July 8, 2021

The Washington State Health Care Authority (HCA) and the Office of the Insurance Commissioner (OIC) have both released information regarding payment to providers for vaccine counseling services. The intent is to encourage vaccine counseling for non-vaccinated patients and address vaccine hesitancy.

For Apple Health enrollees, effective June 28 providers may bill an appropriate established patient evaluation and management code in conjunction with ICD-10 diagnosis code Z71.89. For more information and billing requirements, see the HCA announcement and HCA Vaccine Billing Policy.

In an emergency order, Insurance Commissioner Kreider is requiring state-regulated commercial insurers to cover vaccine counseling. The emergency order assumes providers will bill CPT 99401, 99441 or 98966 for the service with the Z71.89 diagnosis code. The order is currently in effect from July 1 through Aug. 20, 2021. For specific billing requirements, see the emergency order.


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