COVID-19 Vaccine Counseling Procedure Code G0315 Now a Benefit

Date: April 14, 2023

Attention: All Providers

Effective Date: Dates of service on or after December 2, 2021

Call to action: Texas Children Health Plan (TCHP) would like to inform providers that effective for dates of service on or after December 2, 2021, COVID-19 vaccine counseling procedure code G0315 is a benefit of Medicaid for individuals birth through 20 years of age.

How this impacts providers: Procedure code G0315 will be limited to once per day for the same provider, as well as three per rolling year for any provider.

Procedure code G0315 cannot be billed on the same day, by the same provider, for the same client, as any of the following COVID-19 vaccine administration procedure codes:

Procedure code G0315 is a Medicaid benefit for the following providers and places of service:

Procedure code G0315 is a THSteps Program benefit for the following providers and places of service:

Providers interested in enrolling as a COVID-19 vaccinator should visit www.dshs.texas.gov/coronavirus/immunize/provider-information.aspx for more information.

Next steps for providers: Providers are encouraged to share this communication with their staff. Providers are not required to appeal the claims unless they are denied for additional reasons after the claims reprocessing is complete.

If you have any questions, please email Provider Network Management at: providerrelations@texaschildrens.org.

For access to all provider alerts,log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.