Childhood Vaccine Counseling
Impacted Plans: Medicaid and HIV SNP
To: All Primary Care Physicians and Pediatricians
Dear MetroPlusHealth Providers,
To comply with the New York State Medicaid update, effective April 1, 2026, providers will be reimbursed for childhood vaccine counseling provided to members under 21 years of age.
Effective Dates of Service April 1, 2026 onwards,
- Providers may bill CPT code 90483 when childhood vaccine counseling is provided and a vaccine is not administered on the same date of service.
- Providers may continue to bill CPT code 99401 when childhood vaccine counseling is provided, and a vaccine is administered on the same date of service.
Providers may bill either CPT code 90483 or CPT code 99401 for the same date of service, but not both.
| CPT Code | Code Description |
|---|---|
| 99401 | Preventative medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure). Please note: This code is only to be used for vaccine counseling, not other preventive medicine counseling. |
| 90483 | Immunization counseling by physician or other qualified health care professional when immunization(s) is not administered on the same date of service. Please note: This code may be billed for NYS Medicaid members under age 21 when vaccine counseling is provided but vaccination is not performed during that encounter. |
If you have any questions regarding this memo, please contact MetroPlusHealth at [email protected]
Thank you,
MetroPlusHealth