Date: August 7, 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 a maximum of three vaccine counseling services (G0315), per rolling year for each patient. 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 Codes | |||||
| 0001A | 0002A | 0003A | 0004A | 0011A | 0012A |
| 0013A | 0031A | 0034A | 0041A | 0042A | 0044A |
| 0051A | 0052A | 0053A | 0054A | 0064A | 0071A |
| 0072A | 0073A | 0074A | 0081A | 0082A | 0083A |
| 0091A | 0092A | 0093A | 0094A | 0111A | 0112A |
| 0113A | 0124A | 0134A | 0144A | 0154A | 0164A |
| 0173A |
Procedure code G0315 is a Medicaid benefit for the following providers and places of service:
| Place of Service | Provider Type |
| Office | Physician Assistant (PA), Nurse Practitioner (NP), Clinical Nurse Specialist (CNS), Physician, Pharmacist, Certified Nurse Midwife (CNM), Comprehensive Care Program (CCP) Provider, Nephrology (Hemodialysis, Renal Dialysis), Pharmacy |
| Home | PA, NP, CNS, Physician, CCP Provider |
| Outpatient Hospitals | Hospitals, Nephrology (Hemodialysis, Renal Dialysis), Renal Dialysis Facility |
| Other Locations | PA, NP, CNS, Physician, CCP Provider |
Procedure code G0315 is a THSteps Program benefit for the following providers and places of service:
| Place of Service | Provider Type |
| Office | Texas Health Steps Medical |
| Home | Texas Health Steps Medical |
| Outpatient Hospitals | Texas Health Steps Medical |
| Other Locations | Texas Health Steps Medical |
Providers interested in enrolling as a COVID-19 vaccinator should visit www.dshs.texas.gov/coronavirus/immunize/provider-information.aspx for more information.
Next step 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 Relations at: providerrelations@texaschildrens.org.
For access to all provider alerts, log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers