How To Use HCPCS Code G0313

HCPCS code G0313 describes immunization counseling provided by a physician or other qualified healthcare professional when the vaccine(s) is not administered on the same date of service for individuals under the age of 21. This code is specifically used for Medicaid billing purposes.

1. What is HCPCS G0313?

HCPCS code G0313 is a specific code used to identify and bill for immunization counseling services provided to patients under the age of 21. It is important to note that this code is only applicable when the vaccine(s) are not administered on the same date of service. The code represents a counseling session that lasts between 16 and 30 minutes.

2. Official Description

The official description of HCPCS code G0313 is “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, 16-30 mins time.” The short description for this code is “Immunize couns < 21yr 6-30 m."

3. Procedure

1. During an immunization counseling session, the healthcare provider will engage in a conversation with the patient or their guardian regarding the benefits and risks of immunization.
2. The provider will discuss the specific vaccines recommended for the patient’s age group and address any concerns or questions the patient or guardian may have.
3. The counseling session may also involve educating the patient or guardian about the importance of immunizations in preventing diseases and protecting public health.
4. The duration of the counseling session should fall within the range of 16 to 30 minutes to be appropriately billed using HCPCS code G0313.

4. When to use HCPCS code G0313

HCPCS code G0313 should be used when a healthcare provider provides immunization counseling to patients under the age of 21, and the vaccine(s) are not administered on the same date of service. It is important to note that this code is specifically used for Medicaid billing purposes.

5. Billing Guidelines and Documentation Requirements

When billing for immunization counseling using HCPCS code G0313, healthcare providers should ensure that the following documentation requirements are met:

• Documentation should clearly indicate that immunization counseling was provided.
• The duration of the counseling session should be documented to fall within the range of 16 to 30 minutes.
• Any relevant patient information, such as age and reason for not administering the vaccine(s) on the same date of service, should be documented.

6. Historical Information and Code Maintenance

HCPCS code G0313 was added to the Healthcare Common Procedure Coding System on May 11, 2022. As of the effective date, there have been no maintenance actions taken for this code, as indicated by the action code N, which means no maintenance for this code.

7. Medicare and Insurance Coverage

HCPCS code G0313 is designated with the coverage code I, which means it is not payable by Medicare. The pricing indicator code for this code is 99, indicating that the value for reimbursement has not been established. Additionally, the multiple pricing indicator code is 9, which means it is not applicable as HCPCS G0313 is not priced separately by Medicare Part B.

8. Examples

Here are five examples of scenarios where HCPCS code G0313 should be billed:

1. A pediatrician provides immunization counseling to a 17-year-old patient and their parent during a well-child visit. The counseling session lasts for 25 minutes.
2. A family medicine physician provides immunization counseling to a 19-year-old patient who is hesitant about receiving the COVID-19 vaccine. The counseling session lasts for 20 minutes.
3. A nurse practitioner provides immunization counseling to a 15-year-old patient and their guardian during a routine check-up. The counseling session lasts for 18 minutes.
4. A pediatrician provides immunization counseling to a 20-year-old patient who missed their scheduled vaccine appointment. The counseling session lasts for 30 minutes.
5. A primary care physician provides immunization counseling to a 16-year-old patient and their parent who have concerns about the HPV vaccine. The counseling session lasts for 28 minutes.