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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 Codes
0001A0002A0003A0004A0011A0012A
0013A0031A0034A0041A0042A0044A
0051A0052A0053A0054A0064A0071A
0072A0073A0074A0081A0082A0083A
0091A0092A0093A0094A0111A0112A
0113A0124A0134A0144A0154A0164A
0173A

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

Place of ServiceProvider Type
OfficePhysician 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
HomePA, NP, CNS, Physician, CCP Provider
Outpatient HospitalsHospitals, Nephrology (Hemodialysis, Renal Dialysis), Renal Dialysis Facility
Other LocationsPA, 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 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.