Reimbursement policy update: Bundled Services and Supplies - Professional

Effective July 1, 2023, Empire BlueCross BlueShield will update the Bundled Services and Supplies — Professional reimbursement policy to include six Centers for Medicare & Medicaid Services (CMS) immunization counseling codes. These codes will be added to the policy under Section 1: Services and supplies not eligible for separate reimbursement.  

The following codes are not eligible for reimbursement when reported with another service or reported as a stand-alone service:

• G0310 — Immunization counseling by a physician or other qualified healthcare professional when the vaccine(s) is not administered on the same date of service, 5 to 15 minutes time (this code is used for Medicaid billing purposes)
• G0311 — Immunization counseling by a physician or other qualified healthcare professional when the vaccine(s) is not administered on the same date of service, 16 to 30 minutes time (this code is used for Medicaid billing purposes)
• G0312 — Immunization counseling by a physician or other qualified healthcare professional when the vaccine(s) is not administered on the same date of service for ages under 21, 5 to 15 minutes time (this code is used for Medicaid billing purposes)
• G0313 — Immunization counseling by a physician or other qualified healthcare professional when the vaccine(s) is not administered on the same date of service for ages under 21, 16 to 30 minutes time (this code is used for Medicaid billing purposes)
• G0314 — Immunization counseling by a physician or other qualified healthcare professional for COVID-19, ages under 21, 16 to 30 minutes time (this code is used for the Medicaid early and periodic screening, diagnostic, and treatment [EPSDT] benefit)
• G0315 — Immunization counseling by a physician or other qualified healthcare professional for COVID-19, ages under 21, 5 to 15 minutes time (this code is used for the Medicaid EPSDT benefit)

For specific policy details, visit the reimbursement policy page at the empireblue.com provider website.