July 1, 2021
Washington state Executive Order 21-02 allows for billing for COVID vaccine counseling when provided to your patients. Here are the requirements for a
claim to be submitted and paid for dates of service on or after June 24, 2021 and ending August 20, 2021:
- This order is for Washington members only on fully insured plans, SEBB members, and only for COVID-19 vaccine counseling. You can check a patient’s plan status by using the eligibility & benefits tool on Premera.com.
- Check a patient’s vaccination status in the provider’s medical records and the Washington State Immunization Information System (WAIIS) database. Contact only those patients who haven't been fully vaccinated or haven't started vaccinations.
- You must have an established relationship with the patient that includes at least one in-person appointment within the past three years with you or another provider at the same clinic.
- You or your staff must do the outreach.
- You may use video, phone, or in-person. Text messages, email, or voicemail aren’t covered under this order.
- For cost shares to be waived, you must use correct coding when submitting the claim. This includes the correct diagnosis and CPT codes. Fees are based on your current contracted rates:
- CPT Code 99401 – in-person consultation and available for audio and visual telehealth visits
- CPT Code 99441 – audio only (telephone) counseling for physicians
- CPT Code 98966 – audio only (telephone) counseling for non-physicians (medical assistants, nurses, etc.)
- Diagnosis code Z71.89 in the primary position must be included for the claim to process correctly
- There is a limit of two claims per patient, per provider.
We can all work to increase the number of people getting COVID vaccines and decrease the incidence of COVID-related diagnosis and illness.